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PubMed2002

Mediation designs for tobacco prevention research.

This paper describes research designs and statistical analyses to investigate how tobacco prevention programs achieve their effects on tobacco use. A theoretical approach to program development and evaluation useful for any prevention program guides the analysis. The theoretical approach focuses on action theory for how the program affects mediating variables and on conceptual theory for how mediating variables are related to tobacco use. Information on the mediating mechanisms by which tobacco prevention programs achieve effects is useful for the development of efficient programs and provides a test of the theoretical basis of prevention efforts. Examples of these potential mediating mechanisms are described including mediated effects through attitudes, social norms, beliefs about positive consequences, and accessibility to tobacco. Prior research provides evidence that changes in social norms are a critical mediating mechanism for successful tobacco prevention. Analysis of mediating variables in single group designs with multiple mediators are described as well as multiple group randomized designs which are the most likely to accurately uncover important mediating mechanisms. More complicated dismantling and constructive designs are described and illustrated based on current findings from tobacco research. Mediation analysis for categorical outcomes and more complicated statistical methods are outlined.

Adolescent↗
PubMedDate not supplied

Building true collaborations. A senior support network illustrates a successful partnership of healthcare and social service providers.

The relationship between Catholic Social Services (CSS) of the Diocese of Scranton and Mercy Health Partners--Northeast Region, which joined forces last year to develop a senior support network for residents of Wilkes-Barre and the Borough of Kingston, PA, illustrates how collaboration grows out of cooperation and coordination of services. The network is a project of the Neighborhood-Based Senior Care National Initiative, which works to develop collaborations between Catholic health systems and Catholic Charities agencies to help poor communities meet the needs of aging persons. Barriers to successful collaboration may stem from cultural misunderstandings, differences in organizational stability and decision-making processes, attitudes toward money, and even professional vocabularies. Organizations that trust and respect each other can overcome these barriers. The Wilkes-Barre project began simply, but its success established a pattern of cooperation between CSS and Mercy Health Partners, which led to further coordination of referral programs, development of community health profiles, and cross-organizational training. After nine months on the Wilkes-Barre project, CSS and Mercy Health Partners are now developing a Program of All-Inclusive Care for the Elderly (PACE). Effective collaboration between healthcare providers and social service agencies is a long, sometimes difficult, process that requires organizational commitments of time and resources. Organizations must not yield to the temptation to take shortcuts to achieve short-term gains.

Aged↗
PubMedDate not supplied

Foetal alcohol syndrome in Saskatchewan: unchanged incidence in a 20-year period.

Despite major initiatives in public and professional education about foetal alcohol syndrome (FAS) in Saskatchewan in the last 20 years, its incidence rate has not fallen. The rate was 0.515 per 1,000 live births in 1973-1977 and 0.589 in 1988-1992. Two hundred and seven (207) cases were ascertained, the majority being patients of the Alvin Buckwold Child Development Program in Saskatoon. These individuals were severely handicapped: 72% had at least one malformation, the mean intelligence quotient was 67.8 (range 35-106) and 45.9% had a behaviour problem. Only 25.6% still lived with their biological parents when last seen, and only 27 of 108 cases were in a regular class at school without additional support being necessary. New approaches are needed to reduce the incidence of FAS. Emphasis should be placed on individual case-finding, counselling for high-risk women, and community development programs. We are currently attempting this through a provincial coordinating committee.

Adolescent↗
PubMed1991

Grant funding priorities for primary care.

In this time of rapid change in medical education and health care financing, and because of a growing concern that we are not producing enough primary care physicians, it is appropriate that attention be given to significantly rewriting the authorization for Health Manpower Training Grants. Increased funding for primary care health manpower is one of the pieces that has the potential to increase the attractiveness of primary care specialties to students. The Title VII funding authorization has been critical in the support of many predoctoral, residency, and faculty development programs over the last 15 years and has the potential to become even more critical in the next five to 10 years. Specifically, there needs to be a doubling of the authorization of the funding for both the family medicine and the general internal medicine/general pediatric grant sections. The funding priorities need to be reexamined and service objective funding may need to be included. Predoctoral funding cycles should be added to the general internal medicine/general pediatrics 784 grant cycle. Increased creativity and thought should be given to faculty development programs. The academic disciplines and their professional societies, specifically the Ambulatory Pediatrics Association, the Society of General Internal Medicine, and the Society of Teachers of Family Medicine, are supportive of these issues and believe that an increase in funding will increase the effectiveness and output of primary care physicians so that we will be better able to meet the health care needs of our society.

Financing, Government↗
PubMed2004

Detection and quantification of the human IgG4 half-molecule, HL, from unpurified cell-culture supernatants.

The presence and absence of inter-heavy-chain disulphide linkages contribute to the existence of the tetrameric (H(2)L(2)) and half (HL) human IgG molecules, respectively. Reduced effector response in the human IgG4 subclass presents an alternative therapeutic platform in a monoclonal-antibody (mAb) development program. During the initial cell-selection stage, titres of the recombinant human antibody present in crude cell-culture supernatants are determined by ELISA, a technique requiring nanogram quantities of mAb. In the case of an IgG4 antibody, this material is represented mainly by the combination of the tetrameric (H(2)L(2)) and dimeric (HL) forms of the antibody. The determination of concentrations or ratios of tetramer and dimer usually requires at least one chromatographic purification step, and thus frequently this is evaluated later in the mAb development process when the number of potential clones has been reduced. In the present paper we describe a Western-blot-based method that detects and quantifies IgG4 half-molecules, HL, from crude cell-culture supernatants without purification so that H(2)L(2)/HL ratios can be included as a part of early clonal evaluation along with the screening of mAb titres. This method was demonstrated (1) to have a linear HL detection range of 0.5-10 ng, (2) to require microlitre volumes of culture and (3) to react specifically with human IgG4 produced from hybridoma and Chinese-hamster ovary cell cultures. Moreover, this protocol is applicable to evaluate and monitor potential H(2)L(2)/HL variations as a result of changes during the process-development stage of a mAb development program.

Antibodies, Monoclonal↗
PubMed1999

Active suppression of interneuron programs within developing motor neurons revealed by analysis of homeodomain factor HB9.

Sonic hedgehog (Shh) specifies the identity of both motor neurons (MNs) and interneurons with morphogen-like activity. Here, we present evidence that the homeodomain factor HB9 is critical for distinguishing MN and interneuron identity in the mouse. Presumptive MN progenitors and postmitotic MNs express HB9, whereas interneurons never express this factor. This pattern resembles a composite of the avian homologs MNR2 and HB9. In mice lacking Hb9, the genetic profile of MNs is significantly altered, particularly by upregulation of Chx10, a gene normally restricted to a class of ventral interneurons. This aberrant gene expression is accompanied by topological disorganization of motor columns, loss of the phrenic and abducens nerves, and intercostal nerve pathfinding defects. Thus, MNs actively suppress interneuron genetic programs to establish their identity.

Animals↗
PubMed1991

Image enhancement. Developing a program for perioperative nurses.

An image campaign focuses on the strengths of nurses to promote nursing, and in doing so, helps nurses rediscover the values and commitment that are at the heart of the profession. Nursing's image will change when nurses themselves change.

Attitude of Health Personnel↗
PubMed1990

The b alleles of U. maydis, whose combinations program pathogenic development, code for polypeptides containing a homeodomain-related motif.

U. maydis is a fungal pathogen of corn with two forms: one is yeast-like and nonpathogenic; the other is filamentous and pathogenic. The b locus, with 25 different alleles, regulates this dimorphism: any combination of two different alleles triggers pathogenic development, whereas the presence of identical alleles results in the yeast-like form. We have cloned four b alleles (b1, b2, b3, and b4) and show that the b locus contains a single open reading frame (ORF) of 410 amino acids with a variable N-terminal region and a highly conserved C-terminal region (60% and 93% identity, respectively). Mutational analysis confirms that this ORF is responsible for b activity. The b polypeptides appear to be DNA binding proteins because they contain a motif related to the homeodomain in their constant region. We propose that combinatorial interactions between b polypeptides generate regulatory proteins that determine the developmental program of the fungus.

Alleles↗
PubMed2004

Planning HIV education programs for older adults: cultural implications.

In this article the author discusses a needs assessment, through the use of discussion groups of various cultures, exploring the perceptions and attitudes of older adults about human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and HIV education. Five discussion groups (one with Latino older adults, two with African-American older adults, one with White older adults, and one with Chinese-American older adults) were conducted. Semi-structured guiding questions were used with all groups. The questions centered on three major areas: perceptions of older adults and HIV and AIDS, use of condoms for HIV and AIDS prevention, and HIV prevention programs for older adults. The group sessions were approximately 1 hour, were recorded on tape, and were transcribed. The sessions were conducted in the languages of the target population. Because the project was a needs assessment for program development, the number of participants in each cultural discussion group was small, and the nurse group leaders were not experienced in focus group methodology themes and generalizations cannot be made. However, specific findings from the group sessions and recommendations for HIV prevention are presented for further exploration.

Age Factors↗
PubMed1993

Implementing a school-based STD/HIV prevention intervention: collaboration between a university medical center and an urban school district.

To effectively implement a school-based STD/HIV prevention intervention program developed by a community-based agency, several issues must be addressed to build a collaborative partnership between the agency and the school district. Steps taken by the Division of Adolescent Medicine, University of California, San Francisco, in achieving partnership with a local urban school district are outlined. The process of recruiting school district administrators, health education liaisons, teachers, parents, and students is emphasized.

Academic Medical Centers↗
PubMed1999

Technology evolution: the technology spectrum and its application to orthopedic technologies.

The evolution of clinical technologies presents potential adopters with considerations in planning for clinical program development that include the stage and the rate of a technology's evolution. This paper presents a conceptual framework for these considerations and applies the framework to orthopedic technologies. Eight orthopedic surgeons were asked to assess 14 orthopedic technologies and position each of them along a spectrum of research, clinical, and adopted technologies. The distribution of responses for each technology-year combination is presented, and estimates of central tendency, dispersion, and variances provide measures of the change in the distribution of responses over time for each technology and the change in the degree of rater consensus over time for each technology. While orthopedic trauma was chosen to illustrate the technology spectrum model, the model and assessment methodology is applicable to other medical specialties as well. Adoption of this framework in a hospital setting should enable more systematic and effective clinical program development.

Diffusion of Innovation↗
PubMed2005

Bringing violence prevention into the clinic: the Massachusetts Medical Society Violence Prevention Project.

This case study describes the experience of the Massachusetts Medical Society Violence Prevention Program. Beginning in 1996, this program developed materials to support physicians who wanted to incorporate violence prevention into primary care and urgent care practice. With technical assistance from the Harvard Youth Violence Prevention Center, the society produced parent information cards in English and Spanish, a clinical guide, and online training resources. Orders have been received from around the country and from community-based organizations and local governments. The success of this project illustrates the general interest in authoritative and useable violence prevention information.

Adolescent↗
PubMed2001

A systematic review of the safety profile of levetiracetam: a new antiepileptic drug.

PURPOSE: This report provides detailed review of safety information on levetiracetam (LEV) (Keppra), a new antiepileptic drug. METHODS: The integrated summary of safety report submitted for regulatory review was examined to collate information about abnormal laboratory tests values and adverse event reports collected during the overall LEV development program. Analyses included 3347 patients exposed to LEV in clinical trials for epilepsy, cognition, and anxiety disorders. RESULTS: Safety data from all studies depict a similar pattern of adverse effects, predominantly somnolence, asthenia, and dizziness that occurred most frequently during the first month of LEV treatment. Changes in laboratory test values from placebo-controlled trials that were statistically significant remained in the normal range (red blood cells, hematocrit, hemoglobin, white blood cells, and neutrophils). Reports of the coding term 'infection' (common cold, upper respiratory infection) were not preceded by low neutrophil counts that might suggest impaired immunological status. Selection of adverse event coding terms probably contributed to the high rate of adverse effects termed 'infection.' Higher incidences of adverse effects, particularly behavioral effects, were found among epilepsy patients than in elderly patients with cognitive disorders or patients with anxiety disorders given lower doses. CONCLUSIONS: This review of patients evaluated during the clinical development program suggests that LEV was well tolerated and safe for patients with seizure, cognitive and anxiety disorders. Overall incidence of adverse effects in the LEV groups was little higher than reports from the placebo groups. Of course, this data was derived from clinical trials that are of relatively short duration, and provide data on only several thousand patients. Therefore, long-term side effects, and/or rare side effects cannot be ruled out on the basis of this analysis.

Anticonvulsants↗
PubMed1985

The private sector: revenue source of the 80's.

An important and largely untapped source of revenue for community mental health centers is private business and industry. A model describes how one center is meeting the challenge of decreased government funding and budget cutbacks by offering profitable and needed services to local industry. Through the center's human resource consulting firm, Hamilton Associates, five programs are being delivered to businesses: Needs Assessment Programs, Management Training and Development Programs, Employee Assistance Programs, Health and Wellness Promotion Programs, and Selection and Appraisal Programs. The consulting firm publishes a bimonthly newsletter on human resource topics, conducts training workshops for the community, delivers regular speaking presentations to various business associations, and holds "wellness" luncheons to promote individual health. Suggestions and recommendations are given about service offerings, marketing, and development of such services.

Community Mental Health Centers↗
PubMedDate not supplied

The development and implementation of standards of care in a breast cancer screening program.

The development and implementation of process, structure, and outcome standards were an integral part of program development for a mobile mammography screening program that provides service for the economically disadvantaged through the collaborative effort of eight primary healthcare centers, the Dade County Health Department, and the University of Miami/Jackson Memorial Hospital. The standards are used to guide and evaluate the screening program's operation and to provide the framework for additional program components (e.g., developing performance appraisals and quality assurance and risk management programs, establishing policies and procedures, and serving as the foundation for education and research projects). Examples of standards are provided to assist others in developing a systematic and ongoing evaluation plan for mobile mammography screening.

Breast Neoplasms↗
PubMedDate not supplied

Comparing needed training with topics of interest among assisted-living providers.

The purpose of this article is to describe a quality improvement program developed for assisted-living facilities in Washington State and to compare needed training with topics of interest of care providers in these assisted-living facilities. No national educational and training minimum requirements exist for unlicensed personnel charged with caring for older adults in assisted-living facilities. Minimum requirements specified in individual states vary from no training to that required of nursing assistants in skilled nursing facilities. Staff training is needed to ensure quality of care, quality of life, and resident safety.

Aged↗
PubMed1994

A program for developing a comprehensive mathematical description of the crossbridge cycle of muscle.

We describe a computer modeling system for determining the changes of force, fraction of attached crossbridges, and crossbridge flux rate through a specifiable transition in response to length changes imposed on a crossbridge model of muscle. The crossbridge cycle is divided into multiple attached and detached states. The rates of transition from one state to another are defined by rate coefficients that can either be constant or vary with the position of the crossbridge relative to the thin-filament attachment site. This scheme leads to a system of differential equations defining the rates of change for the fractions of bridges in each state. Solutions for this system of equations are obtained at specified times during and after a length change using a method for systems with widely varying time constants (C. W. Gear, 1971, Numerical Initial Value Problems in Ordinary Differential Equations, Prentice-Hall, Englewood Cliffs, NJ). Crossbridges are divided into discrete populations that differ both in their axial displacement with respect to thin filament attachment sites and with respect to the twist of the actin helix. Separate solutions are made for the individual populations and are then averaged to obtain the ensemble response. Force is determined as the sum of the product of the force associated with each state multiplied by the fraction of bridges in that state. A measure of metabolic rate is determined as the net flux through one of the crossbridge transitions. When the force-extension characteristics of the individual crossbridges are linear and the filaments are noncompliant the fraction of attached bridges is equivalent to sarcomere stiffness. To illustrate the operation of the program, we also describe here some results obtained with a simplified scheme.

Actins↗
PubMed2006

Efficacy of an American alcohol and HIV prevention curriculum adapted for use in South Africa: results of a pilot study in five township schools.

The high prevalence of HIV among young people in African countries underscores a pressing need for effective prevention interventions. Adapting school-based prevention programs developed in the United States for use in African schools may present an alternative to the time-consuming process of developing home-grown programs. The researchers report the results of a pretest-posttest field trial of an alcohol/HIV prevention curriculum adapted from an American model and delivered to ninth-grade students in five South African township schools. The revised intervention was based primarily on the Project Northland alcohol prevention and Reducing the Risk safer sex programs. The researchers found significant differences in change from baseline to follow-up between students in intervention and comparison groups on intentions to use a condom; drinking before or during sex; and, among females, sex refusal self-efficacy. The results of the field trial suggest that behavioral interventions developed in Western countries may be rapidly adapted to work in other cultural contexts.

Adolescent↗