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A TinyOS-enabled MICA2-based wireless neural interface.

Existing approaches used to develop compact low-power multichannel wireless neural recording systems range from creating custom-integrated circuits to assembling commercial-off-the-shelf (COTS) PC-based components. Custom-integrated-circuit designs yield extremely compact and low-power devices at the expense of high development and upgrade costs and turn-around times, while assembling COTS-PC-technology yields high performance at the expense of large system size and increased power consumption. To achieve a balance between implementing an ultra-compact custom-fabricated neural transceiver and assembling COTS-PC-technology, an overlay of a neural interface upon the TinyOS-based MICA2 platform is described. The system amplifies, digitally encodes, and transmits neural signals real-time at a rate of 9.6 kbps, while consuming less than 66 mW of power. The neural signals are received and forwarded to a client PC over a serial connection. This data rate can be divided for recording on up to 6 channels, with a resolution of 8 bits/sample. This work demonstrates the strengths and limitations of the TinyOS-based sensor technology as a foundation for chronic remote biological monitoring applications and, thus, provides an opportunity to create a system that can leverage from the frequent networking and communications advancements being made by the global TinyOS-development community.

Amplifiers, Electronic↗

A method for coordinating the distributed transmission of imagery.

Distributed imaging using sensor arrays is gaining popularity among various research and development communities. A common bottleneck within such an imaging sensor network is the large resulting data load. In applications for which transmission power and/or bandwidth are constrained, this can drastically decrease the sensor network lifetime. We present an algorithm that efficiently exploits inter- and intrasensor correlation for the purpose of power-constrained distributed transmission of sensor-network imagery. Gains in network lifetime up to 114% are obtained when using the suggested algorithm with lossless compression. Our results also demonstrate that when lossy compression is employed, much larger gains are achieved. For example, when a normalized root-mean-squared error of 0.78% can be tolerated in the received measurements, the network lifetime increases by a factor of 2.8, as compared to the (optimized) lossless case.

Algorithms↗

Early childhood caries in children aged 6-19 months.

OBJECTIVES: To investigate the relationship between socioeconomic factors, behaviors and the severity of early childhood caries (ECC) in 6-19 month-old Thai children. The severity of ECC was estimated using the proportion of ECC teeth to erupted teeth. This was termed the 'Intensity of ECC' (I-ECC) index. METHODS: Cross-sectional questionnaire survey, dental examinations, and mutans streptococci counts were obtained from children and mothers/caregivers who participated in the ECC prevention program. RESULTS: The 520 children from rural areas were categorized into four age groups by the mean number of erupted teeth. In the 15-19-month-old children, the prevalence of ECC was 82.8% (cavitated caries, 40.8%; noncavitated caries, 42.0%) with a mean ECC teeth score of 4.18 +/- 3.19. The mean I-ECC severity score was 0.45 +/- 0.30 in these toddlers. Children from low-income families, those with low education, and mothers/caregivers with decayed teeth had higher I-ECC scores (P < 0.05). Children who were breast fed or had high counts of mutans streptococci also had higher I-ECC scores (P < 0.05). The logistic regression model revealed that only children's mutans streptococci level was a statistically significant predictor of ECC, with an odds ratio = 4.5 (95% CI = 1.8, 11.7). CONCLUSIONS: ECC is not only a public health problem but also a social problem in Thailand, because it relates to family income and education level. The community development approach to assisting disadvantaged Thai children should be combined with an effective preventive program at a very young age. Future longitudinal research should be performed to improve the I-ECC for measuring the severity of ECC.

Bottle Feeding↗

Promoting benzodiazepine withdrawal.

This paper presents a review of health promotion strategies to help people to stop using benzodiazepines. Four strategies are described and evaluated: health persuasion, personal counselling, state action and community development. It is argued that the first two strategies have been the most popular to date, especially among doctors, and have an important part to play in changing individual behavior. Less consideration has been given to the other two strategies, but these are equally important if a comprehensive policy is to be developed concerned with social as well as individual change.

Anti-Anxiety Agents↗

Assessing the impact of the All-Wales Mental Handicap Strategy: a survey of four districts.

The All-Wales Mental Handicap Strategy (AWS) pledged government leadership and additional resources for the task of developing community based residential, domiciliary, respite, daycare and professional services for people with mental handicaps and their families throughout Wales. Ultimately, the authors of the AWS sought to affect for the better the extent to which people with mental handicaps experience typical community life. A large random sample of people with mental handicaps in four diverse districts was used to track changes in services received, professional input, involvement in individual planning, the number of community activities pursued, and the size and range of individuals' social networks across the middle 4 years of the AWS. The balance between private housing and service residence remained unchanged although, with the ageing of the cohort, there was a decrease in the proportion living with parents and an increase in those living independently or in another family situation. There was an increase in the availability of residential services in the form of ordinary housing and an associated contraction in large congregate care facilities. However, not all moves were towards more ordinary living. Some people moved from large statutory sector specialist facilities to other atypical forms of residence, as did some people from family homes. Family support services in the form of family aides and short-term care increased significantly, but indicators still suggest that an expansion of these services is merited. Day services diversified slightly, but without affecting the major role of the traditional centre. There was a decrease in the numbers receiving a fulltime service. Only a third of the sample received regular individual plan reviews of the services they received and the developmental goals set in their name. In general, individuals were involved in a greater number of community activities that brought them into contact with other citizens. However, such an increase has not led to significant changes in the size or composition of people's friendship networks. Overall, the changes in service provision and family and user experience have been in line with the direction set by the AWS. However, the degree of change still required before the new pattern of services envisaged by the AWS is substantially in existence, or the experience of people with mental handicaps conforms with the guiding principles which underpin it, is considerably greater than that achieved after 7 of its initial 10 years.

Adolescent↗

Serious underreporting of visceral leishmaniasis through passive case reporting in Bihar, India.

OBJECTIVES: Visceral leishmaniasis (VL) is a major public health problem in Bihar, India. Unfortunately, accurate data on the incidence or prevalence of the disease are not available. This longitudinal study was undertaken to determine the incidence of VL in a Community Development Block area of the state of Bihar. Survey results were compared with official reports of the disease to assess the extent of underreporting by the Government health system. METHODS: Three health subcentre areas in Kanti Block, consisting of 14 villages with a total population of 26 444, were selected. Active surveillance was performed every month from January 2001 to December 2003 by house to house survey to detect cases of fever for more than 15 days. Patients clinically suspected of suffering from VL were subjected to parasitological examination for confirmation. Analysis of records of the reporting agencies in the district was undertaken to compare and assess the extent of underreporting. RESULTS: A total of 202 cases of VL were identified in 3 years giving an average annual incidence rate of 2.49/1000 population (95% CI = 2.15-2.83). As identification data of patients was not available with the official reporting agencies for 2001 and 2002, extent of underreporting could be assessed for 2003 only. In the study population, 65 cases of VL were detected during 2003 providing an annual incidence rate of 2.36/1000 population. Only eight (12.30%) cases were reported officially, resulting in underreporting by a factor of 8.13. In 2003, the official incidence rate of VL for Kanti Block was 0.31/1000 against the actual rate of 2.36/1000. As the constraints for official reporting at the block and the district levels are similar, the underreporting at district level was also assumed to be similar. This finding has significance in the preparation for elimination programme.

Adolescent↗

Community maturity, species saturation and the variant diversity-productivity relationships in grasslands.

Detailed knowledge of the relationship between plant diversity and productivity is critical for advancing our understanding of ecosystem functioning and for achieving success in habitat restoration efforts. However, effects and interactions of diversity, succession and biotic invasions on productivity remain elusive. We studied newly established communities in relation to preexisting homogeneous vegetation invaded by exotic plants in the northern Great Plains, USA, at four study sites for 3 years. We observed variant diversity-productivity relationships for the seeded communities (generally positive monotonic at three sites and non-monotonic at the other site) but no relationships for the resident community or the seeded and resident communities combined at all sites and all years. Community richness was enhanced by seeding additional species but productivity was not. The optimal diversity (as indicated by maximum productivity) changed among sites and as the community developed. The findings shed new light on ecosystem functioning of biodiversity under different conditions and have important implications for restoration.

Biodiversity↗

Trends in the prevalence of trachoma, South Australia, 1976 to 1990.

The eye health of rural Aboriginal Australians is known to be poor. Over the past 20 years, Aboriginal communities in remote parts of Australia have had increasing access to eye health services through the National Trachoma and Eye Health Program (NTEHP). Using published and unpublished data, we examined trends in the prevalence of inflammatory trachoma in the Anangu Pitjantjatjara of South Australia. Comparisons using a generalised linear model of surveys in 1976, 1985 and 1990 indicate that there has been a significant reduction in the age-standardised prevalence of inflammatory trachoma in 0- to 20-year-olds. When the 1990 survey was compared with 1976 interim report data from the NTEHP survey, the odds of inflammatory trachoma in 1990 were 0.25 (95 per cent confidence interval (CI) 0.18 to 0.35). When the comparison was with data from the NTEHP survey of the Red Centre, the odds of follicular trachoma in 1990 were 0.51 (CI 0.42 to 0.62), and in comparison with the 1985 NTEHP review data, the odds of inflammatory trachoma in 1990 were 0.28 (CI 0.20 to 0.39). In the older age groups (20 and over), an increase in the prevalence of inflammatory trachoma was found. Although significant, the increase affected a small proportion of the population and may have been because of difficulty in standardising the trachoma grading between surveys, or systematic grading error in the 1990 survey. This study therefore shows that the eye health of Aboriginal people in Central Australia may be improving. The decline in trachoma is welcome and may be caused by improvements in socioeconomic conditions, community development and increasing access to medical care.

Adolescent↗

Does health assessment improve health outcomes in indigenous people? An RCT with 13 years of follow-up.

OBJECTIVE: To examine the impact of a multi-component health assessment on mortality and morbidity in Kimberley Aboriginal residents during a 13-year follow-up. METHOD: A population-based randomised controlled trial using linked hospital, cancer and death records to evaluate outcomes in 620 intervention and 6,736 control subjects. RESULTS: The intervention group had a higher rate of first-time hospitalisation for any reason (IRR=1.37; 95% CI 1.25-1.50), a higher rate of injury-related hospital episodes (IRR=1.31; 95% CI 1.15-1.48) and a higher notification rate of alcohol-related cancers. There was a smaller difference in the rates of multiple hospitalisations (IRR=1.14; 95% CI 0.75-1.74) and no improvement in overall mortality compared with controls (IRR=1.08; 95% CI 0.91-1.29). CONCLUSIONS: There was no overall mortality benefit despite increased health service contact associated with the intervention. IMPLICATIONS: Although not influencing mortality rates, multi-component health assessment may result in a period of increased health service use in Aboriginal and Torres Strait Islander populations, thus constituting an 'intervention'. However, this should not be confused with systematic and sustained interventions and investment in community development to achieve better health outcomes.

Adolescent↗

Lessons from leeches: a call for DNA barcoding in the lab.

Many evolution of development labs study organisms that must be periodically collected from the wild. Whenever this is the case, there is the risk that different field collections will recover genetically different strains or cryptic species. Ignoring this potential for genetic variation may introduce an uncontrolled source of experimental variability, leading to confusion or misinterpretation of the results. Leeches in the genus Helobdella have been a workhorse of annelid developmental biology for 30 years. Nearly all early Helobdella research was based on a single isolate, but in recent years isolates from multiple field collections and multiple sites across the country have been used. To assess the genetic distinctness of different isolates, we obtained specimens from most Helobdella laboratory cultures currently or recently in use and from some of their source field sites. From these samples, we sequenced part of the mitochondrial gene cytochrome oxidase I (COI). Sequence divergences and phylogenetic analyses reveal that, collectively, the Helobdella development community has worked on five distinct species from two major clades. Morphologically similar isolates that were thought to represent the same species (H. robusta) actually represent three species, two of which coexist at the same locality. Another isolate represents part of a species complex (the "H. triserialis" complex), and yet another is an invasive species (H. europaea). We caution researchers similarly working on multiple wild-collected isolates to preserve voucher specimens and to obtain from these a molecular "barcode," such as a COI gene sequence, to reveal genetic variation in animals used for research.

Animals↗

Maternal factors that influence inadequate prenatal care.

Fifty-seven pregnant women who received inadequate prenatal care identified the factors that influenced their decisions related to prenatal care. Data were collected in an institution that serves neighborhood clinics that offer free prenatal care and can be reached by public transportation. Women were interviewed either prenatally (n = 23) or postnatally (n = 34). The interview questions were drawn from the literature on the adequacy of prenatal care. The women identified 22 personal reasons and structural barriers for receiving inadequate prenatal care. The five most frequently cited reasons were small children at home, no medical assistance card, didn't know reason, sadness or ambivalence about the pregnancy, and just moved to the area. Despite demographic risk and facing the similar barriers, some women manage to receive sufficient care and others do not. Presently, government and other policy-making groups often believe that public insurance, Medicaid, or socialized medicine is the answer to our high infant mortality rate. However, in some geographic areas where financial barriers are not factors and where services are available that meet pregnant women's needs, some women still do not enter care early and remain in care. Data that expand knowledge on why women receive inadequate prenatal care will be useful in developing community outreach programs, preparing public service announcements, and designing prenatal services.

Adolescent↗

Performance of the Hamilton Depression Rating Scale in depressed patients in the United Arab Emirates.

Cross-cultural variation in the frequencies and modes of expression of depressive symptoms may influence the validity of depression rating scales. The most widely used instrument for this purpose, namely Hamilton's Depression Rating Scale (HDRS), has not been systematically evaluated in Arab countries. This study evaluates the face validity of the HDRS-21 by studying symptom frequencies, factor structure and symptom clusters in 100 UAE depressed patients. Concurrent validity is tested by comparing total HDRS scores with global estimates of severity made by clinicians, admission status, impairment of social and occupational functioning, and the endogenicity score of the Newcastle (NC) Diagnostic Index. Total HDRS scores show highly significant agreement with three independent measures of severity of depression. Rank orders of the most and least frequent symptoms are consistent with studies of similar design. Marked differences lie in more retardation and somatization and fewer cognitive components in the present study. Principal-component analysis confirmed the heterogeneous structure of the scale, separating a group of core depressive symptoms, and endogenous, somatization, anxiety and psychotic symptom components. The internal consistency (reliability) of the whole scale is moderate, and improves in the core symptom factor. The main conclusion is that the HDRS is sensitive to severity of depression in the UAE culture. However, it measures heterogeneous aspects, and its internal consistency suffers as a result. High levels of retardation and somatization contribute significantly to the total score in socially developing communities.

Adolescent↗

Carcinoma of the oral tongue in northern Finland: trends in overall incidence and patient and tumour characteristics.

A population-based survey was conducted in the two northernmost provinces of Finland to describe the incidence of tongue cancer as well as patient and tumour characteristics in cases diagnosed between 1974 and 1994. A total of 105 new patients with cancer of the oral tongue were included in the 21-year study period. The age-standardised incidence (per 100,000 years) of the carcinoma in men increased from 0.6 in the first 7-year period (1974-1980) to 1.0 in the last period (1988-1994). The incidences in women were 0.7 to 1.4, respectively. The average patient profile remained much the same through the years. The median duration of symptoms also remained the same over the 2 decades, as did the median size and location of the tumour at diagnosis. In conclusion, the incidence of carcinoma of the tongue about doubled in both the male and the female population from 1974 to 1994. However, the patient and tumour characteristics remained about the same, the tumours being relatively large at the time of diagnosis in spite of well-developed community health and dental care.

Adult↗

Transboundary aquifers: a global program to assess, evaluate, and develop policy.

Transboundary aquifers are as important a component of global water resource systems as are transboundary rivers; yet, their recognition in international water policy and legislation is very limited. Existing international conventions and agreements barely address aquifers and their resources. To rectify this deficiency, the International Association of Hydrogeologists and UNESCO's International Hydrological Programme have established the Internationally Shared (transboundary) Aquifer Resource Management (ISARM) Programme. This multiagency cooperative program has launched a number of global and regional initiatives. These are designed to delineate and analyze transboundary aquifer systems and to encourage riparian states to work cooperatively toward mutually beneficial and sustainable aquifer development. The agencies participating in ISARM include international and regional organizations (e.g., Organization of American States, United Nations Environment Programme, United Nations Economic Commission for Europe, Food and Agriculture Organization, and South African Development Community). Using outputs of case studies, the ISARM Programme is building scientific, legal, environmental, socioeconomic, and institutional guidelines and recommendations to aid sharing nations in the management of their transboundary aquifers. Since its start in 2000, the program has completed inventories of transboundary aquifers in the Americas and Africa, and several ISARM case studies have commenced.

Conservation of Natural Resources↗

Factors influencing the utilization of Lyme disease-prevention behaviors in a high-risk population.

PURPOSE: To evaluate factors motivating high-risk individuals to implement Lyme disease-prevention behaviors. DATA SOURCES: Patients presenting to the Lyme Disease Diagnostic Center in New York State completed a voluntary, anonymous questionnaire. CONCLUSIONS: Of the 219 persons completing the questionnaire, participants who reported having had Lyme disease in the past were significantly more likely to use preventive behaviors than those without a history of Lyme disease (p = .01). Additionally, persons who reported having a family member or close friend with Lyme disease were more likely to use preventive behaviors than those without such a relationship (p = .02). Increasing age was associated with increased use of preventive behaviors only for participants without a history of Lyme disease (p = .04). IMPLICATIONS FOR PRACTICE: These findings provide information that may be important in developing community prevention programs for Lyme disease. Younger persons without a history of Lyme disease should be targeted for programs that will educate them about Lyme disease.

Adolescent↗

Graduate medical education for rural physicians: curriculum and retention.

The chronic shortage of rural physicians prompts further consideration of the educational interventions that have been developed to address this issue. Despite rural admission strategies and a variety of undergraduate, graduate and postgraduate curricular innovations, the recruitment and retention of family physicians into many rural areas has not kept pace with the retirement of older general practice physicians. This paper reviews the 1994 American Academy of Family Physicians' rural training recommendations in the light of several recent educational needs assessments. These studies affirm the need for rural residency rotations and the need to maintain and better implement the established rural clinical training guidelines. However, although preparation for rural medical practice has been addressed and is being adequately accomplished in the clinical knowledge and procedural skills areas, instruction and experiences relating to the "realities of rural living" need to be enhanced to increase the retention duration of rural physicians. This can be accomplished with more curricular emphasis on developing community health competencies, including community-oriented primary care (COPC). Physicians who know how to collaborate with community members on health improvement projects have skills that can also facilitate integration and, hence, retention.

Community Health Planning↗

Rural Illinois hospital chief executive officers' perceptions of provider shortages and issues in rural recruitment and retention.

BACKGROUND: It is important to assess rural health professions workforce needs and identify variables in recruitment and retention of rural health professionals. PURPOSE: This study examined the perspectives of rural hospital chief executive officers (CEOs) regarding workforce needs and their views of factors in the recruitment and retention process. METHODS: A survey was mailed to CEOs of 28 Illinois rural hospitals, in towns ranging from 3,396 to 33,530 in population size. The survey addressed CEO perceptions of number of physicians needed by specialty, need for other health professionals, and variables important to recruitment and retention. FINDINGS: Twenty-two CEOs (79%) responded to the survey. Eighty-six percent indicated a physician shortage in the community, with 64% reporting the need for family physicians. CEOs also indicated the need for physicians in obstetrics-gynecology, general and orthopedic surgery, general internal medicine, cardiology, and psychiatry. In terms of needs for other health professionals, most often mentioned were registered nurses (91%), pharmacists (64%), and nurses' aides (46%). Related to recruitment and retention, most often mentioned by the CEOs was community attractiveness in general, followed by practice and physician career opportunities. CONCLUSIONS: CEOs offer 1 important perspective on health professions needs, recruitment, and retention in rural communities. While expressing a range of opinions, rural hospital CEOs clearly indicate the need for more primary care physicians, call for an increased capacity in nursing, and point to community development as a key factor in recruitment and retention.

Attitude of Health Personnel↗

Food-purchasing behaviour in an Aboriginal community. 1. Results of a survey.

Attempts to improve the nutritional status of Aboriginal people through nutritional education programs should be informed by an understanding of contemporary patterns of food procurement, preparation and distribution. This paper describes the results of a survey of food-purchasing behaviour in a central-Australian Aboriginal community. Every transaction occurring in each food outlet in the community over a two-week period was recorded and the data analysed. The results show that women play a much greater role than men in food purchasing, that there is a significant recourse to takeaway foods, that there is a cycle of expenditure determined by distribution of pension and Community Development Employment Project cheques, and that children have sufficient disposable income to be able to provision themselves from the food outlets, so that much of their food consumption is not determined by adult members of their family.

Adolescent↗