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PubMed2004

Genetic structure of seventy cocoyam (Xanthosoma sagittifolium, Linn, Schott) accessions in Ghana based on RAPD.

Seventy cocoyam accessions collected from the eastern and Volta regions of Ghana were studied using RAPD technique. Ten primers were used to study the genetic diversity and structure of the experimental material and a total of 120 different bands were detected. Levels of polymorphic fragments detected by the ten primers ranged from 69.2% to 100%. In the accessions from the eastern region, the mean observed and effective number of alleles per individual per population and mean Nei's gene diversity were 1.99+/-0.01, 1.53+/-0.12 and 0.312+/-0.05, respectively. Mean observed and effective number of alleles per individual per population and Nei's gene diversity were 1.76+/-0.17, 1.44+/-0.16 and 0.264+/-0.08, respectively for the accessions from the Volta region. Considering the entire collections, the mean observed and effective number of alleles per individual per population and Nei's gene diversity for primers were 1.99+/-0.02, 1.54+/-0.12 and 0.319+/-0.05, respectively. In terms of Nei's F-statistics in the subdivided populations for all primers, the overall gene diversity (Ht) ranged from 0.230 to 0.396 with a mean of 0.313+0.06, within sample gene diversity (Hs) ranged from 0.214 to 0.372 with a mean of 0.286+0.06, gene differentiation (Gst) ranged between 0.005 and 0.178 with a mean of 0.086. Geneflow estimate ranged between 2.309 and 99.500 with a mean of 5.314. The accessions grouped into three main clusters. Accession BD96/183 was the most diverse and may be incorporated into cocoyam breeding programs. The 70 accessions did not cluster into their distinct geographical regions suggesting that there may have been movement of germplasm across the two regions.

DNA Primers↗
PubMed1999

Computer-aided learning: an overvalued educational resource?

AIM: The aim of this study was to evaluate the place of computer-aided learning in a basic science course in the undergraduate medical curriculum at the University of Adelaide. METHODS: A software program was written which would allow students to study the anatomy and physiology of the liver and biliary tree in three different styles. Identical content was produced, matched for each style (problem-based, didactic and free text response) and students randomly allocated to one of four groups (three computer and one control). Students were tested before and after access to the program. RESULTS: Ninety second-year students completed the study. Those students who had access to the material in the problem-based and free text response styles did no better in the post-study test than the controls, whilst the group who had studied the didactically presented computer material performed significantly better than the other three groups. All three computer groups accessed the material on a similar number of occasions, but the group who had access to the free text entry program spent significantly less time on computer study. CONCLUSIONS: If computer materials are to be provided as a learning resource for the basic medical sciences, provision must be made for the style of teaching of the course and the style of learning of the students attending that course.

Computer-Assisted Instruction↗
PubMed2004

Expanded state-funded family planning services: estimating pregnancies averted by the Family PACT Program in California, 1997-1998.

OBJECTIVES: The California Family Planning, Access, Care, and Treatment Program was implemented in 1997 to provide family planning services for uninsured, low-income women and men. We estimated the impact on fertility of providing 500 000 women with contraceptives. METHODS: Paid claims and medical record review data were used to estimate pregnancies averted. Pregnancies women experienced while enrolled in the program and pregnancies they would have experienced given methods used before enrollment were modeled as a Markov process. RESULTS: One year of Family Planning, Access, Care, and Treatment services averted an estimated 108 000 unintended pregnancies that would have resulted in 50 000 unintended births and 41 000 induced abortions. CONCLUSIONS: Providing contraceptives to low income, medically indigent women significantly reduced the number of unintended pregnancies in California.

Abortion, Legal↗
PubMed1994

The accessibility of drug treatment for pregnant women: a survey of programs in five cities.

Through simulated calls to 294 drug treatment programs in five cities, this study investigated access for pregnant women and compared New York City's provision of services in 1989 to that in 1993. In all sites, the majority of programs accepted pregnant women. There was also a marked improvement in the availability of services in New York City. Yet options were more limited for Medicaid recipients and women needing child care, and an appointment or referral for prenatal care was usually not offered. Although the door for treatment may be opening for pregnant women, institutional barriers still remain.

Child Care↗
PubMed1985

A microcomputer method for designing optimal experiments for estimating enzyme kinetic parameters.

A computer program, written in BASIC, for designing optimal experiments with the aim of evaluating estimates of the parameters for any enzyme kinetic model is given. This computer program can be run on any microcomputer with less than 32 Kbytes of random access memory. The program uses the termed D-optimization design criterion, which minimizes the determinant of the variance-covariance matrix. The user only supplies the rate equation, the maximum and minimum concentrations of substrates and inhibitors, the weighting pattern, and the best possible values of the parameters. The computer supplies the optimal substrate and inhibitor concentrations (one for each parameter), for estimating the parameter values, and the determinant of the variance-covariance matrix. Likewise, the microcomputer supplies the eigenvalues and eigenvectors of information and redundancy matrices, the sensitivity and the global redundancy.

Biometry↗
PubMed2000

The reliability and internal consistency of an Internet-capable computer program for measuring utilities.

OBJECTIVE: The purpose of this study was to assess the reliability and internal consistency of measurements of utilities performed with a computer program (iMPACT2) designed for Internet surveys and Internet patient decision-support systems. METHODS: We implemented the Internet Multimedia Preference Assessor Construction Tool, version 2 (iMPACT2) program using the combination of a web server, HTML files, and a web-accessible database. The program randomized subjects, screened their responses for missing data and failures of internal consistency, assisted patients with resolving certain inconsistencies, and, upon a subject's completion of the protocol, provided a report of results to the research assistant administering the program. To validate the iMPACT2 program, we recruited 60 healthy community volunteers and elicited preferences in a research-lab setting using a visual analog scale (VAS) and the standard gamble (SG) for subject's current health and three hypothetical states. For purposes of comparison, we also administered a Short Form-12 (SF-12) health-assessment questionnaire. Subjects used the computer software on two occasions separated by 2-4 weeks of time. RESULTS: Visual analog scale and standard gamble ratings for subjects' current health were reliable (intraclass correlation coefficient (ICC) of 0.82 and 0.84 (two outliers excluded -0.60 without exclusions), respectively) were comparable with the reliability of the Physical and Mental Component scales of the SF-12 (ICCs of 0.84 and 0.75, respectively). Subjects could easily discriminate between hypothetical states (D scores 0.74 for SG and 0.90 for VAS), and 94% had a completely internally consistent ordering of preference ratings for states. CONCLUSIONS: iMPACT2 produces measurements of standard gamble utilities that are reliable and have a high degree of internal consistency. Procedures for assessment of utilities developed for desktop computer programs can be translated to software designed for the Internet, facilitating the use of utilities and endpoints in clinical trials and development of web-based decision-support applications for patients. However, further testing, including direct comparisons with traditional interviewer administered utility elicitation protocols, is needed.

Analysis of Variance↗
PubMed2004

Management training for pathology residents: a regional approach.

CONTEXT: Success in the practice of pathology demands proficiency in management, but management training for pathology residents is generally inadequate, with little agreement on an appropriate curriculum or competency assessment. Most residency training programs do not have faculty members who are interested and have expertise in management and who are dedicated to and have time available for teaching. OBJECTIVE: To develop a didactic management training program for the residents from 6 separate pathology residency programs in Southern California, with a comprehensive curriculum taught by experts in each area without undue burden on any single training program. METHODS: Faculty from the University of California-Los Angeles and the University of Southern California reviewed the literature and the management needs of practicing pathologists and devised the curriculum. Pathologist and nonpathologist speakers were identified who were working in important management positions both regionally and nationally. Seminars were presented in alternate months during a 2-year period. Sessions were videotaped, and each session was evaluated by the attendees. RESULTS: The curriculum consisted of 12 major topics, and seminars were delivered by 15 presenters from 6 institutions. Attendance was highest for residents in postgraduate years 2 and 3. The overall evaluation scores were exceedingly high (4.66 of a possible 5.0), and residents reported a significant increase in subject knowledge. Videotaping of presentations provided flexibility for residents who were unable to attend the seminars. CONCLUSION: This program was effective and could serve as a template for other pathology residency training programs to establish curriculum content and develop resident competency. Teaching responsibilities were less burdensome when spread among several programs and when supplemented by nonpathology faculty. Electronic and audiovisual support enhanced flexibility and access to the program.

Internship and Residency↗
PubMed2002

[Access for all to quality drugs].

The implementation of essential drugs policies and widespread use of generic products in humanitarian programs has ensured access to medication for poverty-stricken populations. However rigorous drug selection according to origin is necessary to guarantee quality. A drug is more than a mixture of chemical components, it depends on a complex balance that can be affected by numerous factors. To be beneficial to the patient, a drug must be manufactured, purchased, distributed and administered in a strictly professional and responsible manner. An obvious danger for drugs such as antibiotics is that use of poor quality products producing insufficient bioavailability will promote development of microbial resistance. This could become a worldwide public health problem with particularly dramatic consequences for the treatment of tuberculosis and retroviruses.

Biological Availability↗
PubMed2002

General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP).

This report is a revision of General Recommendations on Immunization and updates the 1994 statement by the Advisory Committee on Immunization Practices (ACIP) (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1994;43[No. RR-1]:1-38). The principal changes include expansion of the discussion of vaccination spacing and timing, recommendations for vaccinations administered by an incorrect route, information regarding needle-free injection technology, vaccination of children adopted from countries outside the United States, timing of live-virus vaccination and tuberculosis screening, expansion of the discussion and tables of contraindications and precautions regarding vaccinations, and addition of a directory of immunization resources. These recommendations are not comprehensive for each vaccine. The most recent ACIP recommendations for each specific vaccine should be consulted for additional details. This report, ACIP recommendations for each vaccine, and other information regarding immunization can be accessed at CDCs National Immunization Program website at http.//www.cdc.gov/nip (accessed October 11, 2001).

Adolescent↗
PubMed1993

Physician-directed software design: the role of utilization statistics and user input in enhancing HELP results review capabilities.

The M.D. Rounds Report program was developed and implemented in June of 1992 as an adjunct to the HELP System at Rex Hospital. The program facilitates rapid access to information on allergies and current medications, laboratory results, radiology reports and therapist notes for a list of patients without physicians having to make additional menu or submenu selections. In planning for an upgrade of the program, utilization statistics and user feedback provided valuable information in terms of frequency of access, features used and unused, and the value of the program as a reporting tool in comparison to other online results reporting applications. A brief description of the functionality of the M.D. Rounds Report, evaluation of the program audit trail and user feedback, planned enhancements to the program, and a discussion of the prototyping and monitoring experience and the impact on future physician subsystem development will be presented.

Computer Systems↗
PubMedDate not supplied

Future of emergency contraception lies in pharmacists' hands.

OBJECTIVE: To increase community pharmacists' awareness about issues related to the provision of emergency contraception (EC) to women by describing pharmacist outreach and training programs and discussing pharmacy access and stocking issues, California's EC Pharmacy Program, methods for raising pharmacists' awareness, and professional development opportunities. SUMMARY: EC is both safe and effective in reducing the risk of unintended pregnancy after unprotected intercourse, yet awareness of and demand for the medication has not been high, and it often is not stocked in pharmacies. Various advocacy organizations have engaged in educating the public and physicians about EC, but relatively little attention and few resources have been targeted to ensure that the pharmacy community is aware of and educated about EC. Increased visibility and access to EC in the several states that allow pharmacists to provide EC directly to women have resulted from the active participation and leadership of pharmacists. In these states, women are showing interest in and receptivity to reproductive health services provided by pharmacists. In California, some 3000 pharmacists statewide have completed training, and in 2004 they provided EC directly to approximately 175,000 women. Pharmacists who provide EC overwhelmingly (91%) report that they do so because they see it as an important community service, and many (57%) recognize the opportunity for professional development. CONCLUSION: Pharmacists are uniquely positioned to improve access to EC, and leadership within the pharmacy community can facilitate efforts to improve access. Increased education and training of pharmacists about EC--such as continuing education programs available online at www.pharmacyaccess. learnsomething.com--are critical to ensure not only that EC is available in pharmacies but also that pharmacists are engaged in meeting the reproductive health needs of women. Increased access to EC can expand pharmacists' role in health care provision. State-specific information about EC pharmacy access initiatives is available on the Web at www.GO2EC.org.

California↗
PubMed2006

Determinants of mortality and nondeath losses from an antiretroviral treatment service in South Africa: implications for program evaluation.

BACKGROUND: The scale-up of antiretroviral treatment (ART) services in resource-limited settings requires a programmatic model to deliver care to large numbers of people. Understanding the determinants of key outcome measures--including death and nondeath losses--would assist in program evaluation and development. METHODS: Between September 2002 and August 2005, all in-program (pretreatment and on-treatment) deaths and nondeath losses were prospectively ascertained among treatment-naive adults (n=1235) who were enrolled in a community-based ART program in South Africa. RESULTS: At study censorship, 927 patients had initiated ART after a median of 34 days after enrollment in the program. One hundred twenty-one (9.8%) patients died. Mortality rates were 33.3 (95% CI, 25.5-43.0), 19.1 (95% CI, 14.4-25.2), and 2.9 (95% CI, 1.8-4.8) deaths/100 person-years in the pretreatment interval, during the first 4 months of ART (early deaths), and after 4 months of ART (late deaths), respectively. Pretreatment and early treatment deaths together accounted for 87% of deaths, and were independently associated with advanced immunodeficiency at enrollment. Late deaths were comparatively few and were only associated with the response to ART at 4 months. Nondeath program losses (loss to follow-up, 2.3%; transfer-out, 1.9%; relocation, 0.7%) were not associated with immune status and were evenly distributed during the study period. CONCLUSIONS: Loss to follow-up and late mortality rates were low, reflecting good cohort retention and treatment response. However, the extremely high pretreatment and early mortality rates indicate that patients are enrolling in ART programs with far too advanced immunodeficiency. Causes of late access to the ART program, such as delays in health care access, health system delays, or inappropriate treatment criteria, need to be addressed.

Adult↗
PubMedDate not supplied

Arizona Telemedicine Program: implementing a statewide health care network.

The Arizona Telemedicine Program was established in July 1996 by the Arizona state legislature. The organizational center for the program is the Arizona Health Sciences Center in Tucson. Key goals for the program include increased access to specialty services for rural, underserved populations; development of cost-effective telemedicine services; and expansion of opportunities for education of health professionals in rural areas. The program provides several levels of services based on both store-and-forward and real-time interactive applications. The telecommunication infrastructures is provided by two methods: The first is a private asynchronous transfer mode network established and operated by program personnel. The second is dial-up access via the public switched telephone network. After an extensive period of organization and vendor evaluations, most of the private network was implemented between June and December 1997. This paper describes experiences establishing the asynchronous transfer mode network.

Arizona↗
PubMed2001

Clinical features and prognosis of nonepileptic seizures in a developing country.

PURPOSE: To determine the predictive value of clinical features and medical history in patients with nonepileptic seizures (NESs). METHODS: One hundred sixty-one consecutive ictal video-EEGs were reviewed, and 17 patients with 41 NESs identified. NES diagnosis was defined as paroxysmal behavioral changes suggestive of epileptic seizures recorded during video-EEC without any electrographic ictal activity. Clinical features, age, sex, coexisting epilepsy, associated psychiatric disorder, social and economic factors, delay in reaching the diagnosis of NES, previous treatment, and correlation with outcome on follow-up were examined. RESULTS: The study population included 70% female patients with a mean age of 33 years. Mean duration of NESs before diagnosis was 9 years. Forty-one percent had coexisting epilepsy. The most frequent NES clinical features were tonic-clonic mimicking movements and fear/anxiety/hyperventilation. The most common psychiatric diagnosis was conversion disorder and dependent and borderline personality disorder. Seventy-three percent of patients with pure NESs received antiepileptic drugs (AEDs), and 63.5% of this group received new AEDs. Fifty-nine percent of the patients received psychological/psychiatric therapy. At follow-up, 23.5% were free of NESs. CONCLUSIONS: All seizure-free patients had two good prognostic factors: having an independent lifestyle and the acceptance of the nonepileptic nature of the episodes. Video-EEG monitoring continues to be the diagnostic method to ensure accurate seizure classification. Establishing adequate health care programs to facilitate access to new technology in public hospitals as well as the implementation of continuous education programs for general practitioners and neurologists could eventually improve the diagnosis and treatment of patients with NESs.

Adolescent↗
PubMed2005

Development and implementation of an online master's degree in education program for health care professionals.

Technological advances, especially the Internet and the World Wide Web, have drastically changed educational practices by reforming the concept of education and knowledge transmission at a distance. Professionals in all disciplines have begun using this advanced technology to expand the number of learning opportunities for intellectual growth and professional development. As a result, many universities and educational institutions now offer online higher degree programs to provide opportunities for nontraditional students who have difficulty attending scheduled, campus-based classes. In medicine, a need has been identified for advanced graduate studies in education to develop the next generation of medical educators and to train them in educational research methods to validate their educational efforts. This need was identified by both informal needs assessment at local, regional, and national faculty development meetings and more formal literature review and government survey. The faculty development team of Cincinnati Children's Hospital Medical Center (Department of Pediatrics, University of Cincinnati College of Medicine) collaborated with the College of Education to develop an online Master's Degree in Education for health care professionals. The program was designed to apply these advanced technologies in order to make the program flexible and accessible to health care professionals whose busy schedules preclude more traditional, in-class graduate programs. This article presents how this program evolved and the problems, challenges, and solutions associated with the development and implementation of the program.

Education, Distance↗
PubMed1984

Masseter, digastric and omohyoidal responses from weak mechanical oral stimuli in the chewing rat.

In rats anesthetized with ketamine, effects of jaw jerks (rise time 5 ms, strength 70 mN) applied in the open direction were studied both in the quiescent preparation and during rhythmic jaw-opening and jaw-closing movements (induced by mechanical stimulation of the palate). The left masseter, posterior and anterior digastric and omohyoid muscles were fitted with electrodes for recording electromyographic responses. In the quiescent state a jaw jerk causes responses in all recorded muscles. In the rhythmic preparation masseter responses persisted but digastric and omohyoidal responses were suppressed. This suppression was most prominent when jerks were applied during closing. However, responses in digastrics and omohyoid persisted when masseter nerves and periodontal afferents of the lower incisors were blocked with xylocaine. The suppression of digastric and omohyoidal responses therefore originates--at least partly - from masseter and periodontal afferents. When the periodontal afferents alone were blocked with xylocaine only the response in the opening phase persisted. The suppression of digastric and omohyoidal responses during opening are therefore reflexes from periodontal receptors. These observations support the concept that oral activity is controlled by two relatively independent systems. The first program-oriented system generates the basic movements whereas the second, environment-oriented, system has access to the program for correcting perturbations. There is evidence that muscles poorly supplied with muscle spindles (digastrics and omohyoid) act as pure effectors. Modulation of their activity is prompted by exteroceptors and muscle receptors in the masticatory muscles.

Afferent Pathways↗
PubMedDate not supplied

College smoking-cessation using cell phone text messaging.

Although rates of smoking among college-aged students continue to rise, few interventions that focus on college smokers' unique motivations and episodic smoking patterns exist. The authors developed and evaluated a prototype program targeting college students that integrates Web and cell phone technologies to deliver a smoking-cessation intervention. To guide the user through the creation and initialization of an individualized quitting program delivered by means of cell phone text messaging, the program uses assessment tools delivered with the program Web site. Forty-six regular smokers were recruited from local colleges and provided access to the program. At 6-week follow-up, 43% had made at least one 24-hour attempt to quit, and 22% were quit--based on a 7-day prevalence criterion. The findings provide support for using wireless text messages to deliver potentially effective smoking-cessation behavioral interventions to college students.

Adolescent↗
PubMed2002

Has Medicaid managed care affected beneficiary access and use?

This paper uses data from the 1997 National Survey of America's Families to examine the effects of the various forms of mandatory Medicaid managed care on access and use among beneficiaries not receiving Supplemental Security Income or Medicare benefits. The results show that mandatory health maintenance organization (HMO) programs have had a positive impact on both children and adults, particularly when compared to Medicaid fee-for-service plans. We observed less dependence on emergency rooms as a usual source of care, a greater probability of visiting a doctor and, for children, greater use of preventive care. In contrast, mandatory primary care case management plans (PCCM) provided some benefits to children, but appeared to have very little impact on adult Medicaid beneficiaries. Mandatory programs that use both HMOs and PCCM produced mixed results. With the exception of mandatory HMO programs, discrepancies in access and use continue to exist between Medicaid managed care enrollees and low-income privately insured people.

Adult↗