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PubMed1989

Evaluation of nutritional and immunization services in a tribal ICDS block of Rajasthan.

The evaluation of nutritional and immunization services was undertaken in the tribal ICDS block Kherwara (Rajasthan) by comparing the results of door to door surveys conducted on pretested schedules in six randomly selected Anganwadi Villages at the start (1983) and after completion of 4 years of the project (1987). A significant improvement (p less than 0.001) was found in nutritional status of children below 6 years of age. Except for BCG, the study revealed improved vaccination coverage. However, the achievements were far less than the targets laid under the National Health Policy. Concerted efforts are required to improve the services further for achieving the desired goals.

Child Health Services↗
PubMed1989

Healthy students as adult citizens (mental health of the Finnish student. Follow-up, report V).

The longitudinal research project dealing with the mental health of Finnish students was started in the year 1965. This paper is the fifth follow-up report from research phase III. It describes the most healthy subgroup by contrasting it with the ill subgroup. Time and sex as well as external and internal reality are essential aspects of this comparison between the healthy and the ill. Differences between the healthy and the ill have been described in terms of a) external facts, b) background information (phases I and II) and c) subjective inner feelings. The special character of mental health and illness in men and women is also discussed from several points of view. In the attempt to interpret the extensive body of data and to give it a coherent shape, one general hypothesis which has been formed is that women tend to be characterized by a greater 'mobility' between the more mature, adult level and an earlier one, reaching back all the way to the oral aspects of the dyadic relationship. Such mobility and flexibility has both its advantages and its disadvantages. The specific aspects of women's difficulties are easily obscured by the duality of the roles taken on by the woman, and the great difference between them - that of adult woman and that of mother. In particular the maternal role easily comes to mask problematic early elements, which under subsequent conditions of stress may be activated. The male personality is more definite and clearcut in this respect, but by the same token also more rigid.

Adaptation, Psychological↗
PubMed1987

Hair cell distributions in the normal human cochlea.

This supplement presents the results of a collaborative project between workers from several European nations. The study was started in order to provide data describing the distribution of the sensory hair cells in the normal human cochlea and to allow the evaluation of age-related changes in the hair cell density. Fifty-three cochleas (including nine from fetuses) were preserved by perilymphatic perfusion with fixative shortly after death. In the non-fetal material the hearing was clinically normal prior to death. Some subjects had audiograms available and these also had to be normal for their age for inclusion of the cochlea in the study. Dissection of cochleas permitted surface preparation techniques to be used to count the hair cells and allow the hair cell density to be described as inner or outer hair cells per mm. The total length in mm of each cochlea was also measured (Length). The location of each hair cell density count was defined as distance in mm from the base (Distance), distance in mm from the apex (Length minus Distance), or as a proportion of the total length of the cochlea when the location of that count was measured as distance from the base (Distance/Length). The material was allocated to one of six age bands. For each age band and at each point in the cochlea for which data existed the average hair cell density and its standard deviation were calculated. This allowed average cytocochleograms to be drawn for both inner and outer hair cells. The proportional method of representation of location within the cochlea gave the best fit of the available data and the proportional cytocochleograms are presented, although the data for all three methods are included in tabular form. The average cytocochleograms indicate a progressive age-related loss of outer hair cells. This loss was exacerbated at both the apical and basal ends of the cochlea. The overall loss was less marked for the inner hair cell population but was accentuated at the base, like that of the inner hair cells, although not at the apex. With the proportional datasets, and taking fetal age as zero, a model of hair cell loss was developed. A simple linear equation in the form: Hair cell density(i) = (Age in years X Age Coefficient(i)) + Constant(i) gave the best fit at each proportional location (i) for both inner and outer hair. The age coefficients and constants are given in tables for inner and outer hair cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Cell Count↗
PubMed2003

Federal funding of endoscopic research in the United States: 1972-2002.

BACKGROUND: Funding for research is critical to the determination of appropriate applications for endoscopy in clinical practice. We sought to evaluate trends in funding provided by the National Institutes of Health (NIH) for endoscopic research from 1972 through 2002. METHODS: The NIH database of funded biomedical projects for the years 1972 through 2002 was searched using the Computerized Retrieval of Information on Scientific Projects (CRISP) and the keyword "endoscopy." Grants were included if a start date, title, and/or specific aims were available. Grants were classified as primary endoscopy if the title or specific aim had an endoscopy focus. Endoscopy funding was compared with other nonendoscopic funding for the same period. RESULTS: From 1972 through 2002, 133 endoscopy-related grant applications were funded and 98 met inclusion criteria. Funding for endoscopic research increased from one grant (1972-1982) to 4 grants (1983-1992) to 93 grants (1993-2002), a 2325% increase for the 1993-2002 decade alone. Despite this increase, there were substantially fewer funded endoscopy-related applications compared with liver disease (61,804 grants), Helicobacter pylori (866 grants), and cardiac catheterization (1547 grants). Among endoscopic grants, colorectal cancer projects accounted for the largest portion (34%), followed by advanced optical technologies (18%) and Barrett's esophagus (17%). CONCLUSIONS: Funding for endoscopic research by the NIH has increased dramatically over the past 30 years, but it still lags behind funding in other fields. Projects focused on colorectal cancer, Barrett's esophagus, and optical technologies were most common among those funded, and the National Cancer Institute was the primary source of funding.

Budgets↗
PubMed2005

Bursts of information: coordinating interneurons encode multiple parameters of a periodic motor pattern.

The limbs on different segments of the crayfish abdomen that drive forward swimming are directly controlled by modular pattern-generating circuits. These circuits are linked together by axons of identified coordinating interneurons. We described the distributions of these neurons in each abdominal ganglion and monitored their firing during expression of the swimming motor pattern. We analyzed the timing, the numbers of spikes, and the duration of each burst of spikes in these coordinating neurons. To see what information these neurons encoded, we correlated these parameters with the timing, durations, and strengths of bursts of spikes in motor axons from the same modules. During the power-stroke phase of each output cycle, the anterior-projecting neurons fired bursts of spikes that encoded information about the start-time, duration, and strength of each burst of spikes in power-stroke motor neurons from the same module. When the period and intensity of the motor output fluctuated, the bursts of spikes in these neurons tracked these fluctuations accurately. Each additional spike in these neurons signified an increase in the strength of the power-stroke burst. The posterior-projecting neurons that fired during the return-stroke phase encoded similar information about the return-stroke motor neurons. Although homologous neurons from different ganglia were qualitatively similar, neurons from posterior ganglia fired significantly more spikes per burst than those from more anterior ganglia, a segmental gradient that correlates with the normal posterior-to-anterior phase progression of limb movements. We propose that this gradient and a similar gradient in the durations of bursts in power-stroke motor neurons might reflect a hitherto-undetected difference in the excitation or intrinsic excitability of swimmeret modules in different segments.

Action Potentials↗
PubMedDate not supplied

The Malta Project--a country freed itself of leprosy. A 27-year progress study (1972-1999) of the first successful eradication of leprosy.

The successful conclusion of the first leprosy eradication program carried out with combination therapy is reported. This program started in Malta in June 1972. It was based on extensive experimental and clinical studies and was formally concluded on 31 December 1999. No new infections occurred after the start of this 27-year progress report. The youngest patient was 16, and the eldest 83 years old. Of the total of 261 cases in the project, 201 had already received pretreatment [mainly with diaminodiphenylsulfone (DDS)] at the start. Sixty-one cases had no pretreatment. These were predominantly elderly patients who were late in deciding to have treatment. The very long follow-up period totaling 27 years was consistently maintained in order to be able to refute all potential objections empirically, e.g. with regard to relapses at a late stage. Besides the overall symptoms which are typical for the broad picture of leprosy, the involvement of the eyes was very striking (at least 50%). The therapeutic effect was of very rapid onset in these cases without surgery. Rifampicin (RMP) + isoniazid + prothionamide + DDS (trade name Isoprodian-RMP) was used as medication in a fixed combination. This fixed combination had already proved to be highly effective in the treatments during the course of the project, surprising therapy results (including lifesaving effects) were also noticed in other diseases.

Aged↗
PubMed2003

Focal spot motion of linear accelerators and its effect on portal image analysis.

The focal spot of a linear accelerator is often considered to have a fully stable position. In practice, however, the beam control loop of a linear accelerator needs to stabilize after the beam is turned on. As a result, some motion of the focal spot might occur during the start-up phase of irradiation. When acquiring portal images, this motion will affect the projected position of anatomy and field edges, especially when low exposures are used. In this paper, the motion of the focal spot and the effect of this motion on portal image analysis are quantified. A slightly tilted narrow slit phantom was placed at the isocenter of several linear accelerators and images were acquired (3.5 frames per second) by means of an amorphous silicon flat panel imager positioned approximately 0.7 m below the isocenter. The motion of the focal spot was determined by converting the tilted slit images to subpixel accurate line spread functions. The error in portal image analysis due to focal spot motionwas estimated by a subtraction of the relative displacement of the projected slit from the relative displacement of the field edges. It was found that the motion of the focal spot depends on the control system and design of the accelerator. The shift of the focal spot at the start of irradiation ranges between 0.05-0.7 mm in the gun-target (GT) direction. In the left-right (AB) direction the shift is generally smaller. The resulting error in portal image analysis due to focal spotmotion ranges between 0.05-1.1 mm for a dose corresponding to two monitor units (MUs). For 20 MUs, the effect of the focal spot motion reduces to 0.01-0.3 mm. The error in portal image analysis due to focal spot motion can be reduced by reducing the applied dose rate.

Artifacts↗
PubMedDate not supplied

Bootstrap finance: the art of start-ups.

Entrepreneurship is more popular than ever: courses are full, policymakers emphasize new ventures, managers yearn to go off on their own. Would-be founders often misplace their energies, however. Believing in a "big money" model of entrepreneurship, they spend a lot of time trying to attract investors instead of using wits and hustle to get their ideas off the ground. A study of 100 of the 1989 Inc. "500" list of fastest growing U.S. start-ups attests to the value of bootstrapping. In fact, what it takes to start a business often conflicts with what venture capitalists require. Investors prefer solid plans, well-defined markets, and track records. Entrepreneurs are heavy on energy and enthusiasm but may be short on credentials. They thrive in rapidly changing environments where uncertain prospects may scare off established companies. Rolling with the punches is often more important than formal plans. Striving to adhere to investors' criteria can diminish the flexibility--the try-it, fix-it approach--an entrepreneur needs to make a new venture work. Seven principles are basic for successful start-ups: get operational fast; look for quick break-even, cash-generating projects; offer high-value products or services that can sustain direct personal selling; don't try to hire the crack team; keep growth in check; focus on cash; and cultivate banks early. Growth and change are the start-up's natural environment. But change is also the reward for success: just as ventures grow, their founders usually have to take a fresh look at everything again: roles, organization, even the very policies that got the business up and running.

Capital Financing↗
PubMed1985

Development of cortical afferents and cortico-tectal efferents of the mammalian (rat) primary visual cortex.

At the time when the fibres from the striate cortex (area 17) begin to innervate the superficial layers of the superior colliculus of the young rat (postnatal days 4 and 5) a high degree of specificity in the organization of this newly formed cortico-tectal projection is already apparent. Thus, in young rats, as in adult mammals of virtually all species studied so far, the somata of cortico-tectal neurones are confined to lamina V of the ipsilateral cortex. However, this high degree of laminar (radial) specificity in young animals is accompanied by a substantial degree of exuberance as indicated by a tangential distribution of the cortico-tectal cells which is wider than that in the adult. The exuberant projections are pruned during the second postnatal week. The cortico-cortical associational and commissural fibres start to enter the grey matter of the rat striate cortex after postnatal day 7. Again a high degree of specificity in the laminar distribution of those newly established projections is apparent. However, the cortico-cortical projection, at the time when cortico-cortical fibres enter the cortical laminae, is clearly exuberant since the tangential spread of cortical cells projecting to the striate cortex is wider than that in the adult. Pruning of these excessive projections takes place some time after postnatal day 14. It is believed that understanding the mechanism(s) underlying the development of connections of the rat visual cortex might be of general importance in understanding developmental abnormalities in the pattern of interconnections of the visual cortices of other mammalian orders.

Afferent Pathways↗
PubMed2006

Estimating and projecting HIV prevalence and AIDS deaths in Tanzania using antenatal surveillance data.

BACKGROUND: The Estimations and Projections Package (EPP 2005) for HIV/AIDS estimates and projects HIV prevalence, number of people living with HIV and new HIV infections and AIDS cases using antenatal clinic (ANC) surveillance data. The prevalence projection produced by EPP can be transferred to SPECTRUM, a demographic projection model, to calculate the number of AIDS deaths. This paper presents estimates and projections of HIV prevalence, new cases of HIV infections and AIDS deaths in Tanzania between 2001 and 2010 using the EPP 2005 and SPECTRUM soft-wares on ANC data. METHODS: For this study we used; the 1985-2004 ANC data set, the 2005 UN population estimates for urban and rural adults, which is based on the 2002 population census, and results of the 2003 Tanzania HIV Indicator Survey. The ANC surveillance sites were categorized into urban and rural areas on the basis of the standard national definitions of urban and rural areas, which led to 40 urban and 35 rural clinic sites. The rural and urban epidemics were run independently by fitting the model to all data and on level fits. RESULTS: The national HIV prevalence increased from 0% in 1981 to a peak of 8.1% in 1995, and gradually decreased to 6.5% in 2004 which stabilized until 2010. The urban HIV epidemic increased from 0% in 1981 peaking at 12.6% in 1992 and leveled to between 10.9% and 11.8% from 2003 to 2010. The rural epidemic peaked in 1995 at 7.0% and gradually declined to 5.2% in 2004, and then stabilized at between 5.1% and 5.3% from 2005 to 2010. New infections are projected to rise steadily, resulting in 250,000 new cases in 2010. Deaths due to AIDS started in 1985 and rose steadily to reach 120,000 deaths in 2010, with more females dying than men. CONCLUSION: The fact that the number of new infections is projected to increase steadily to reach 250,000 per year in 2010 calls for more concerted efforts to combat the spread of HIV infection particularly in the rural areas where the infrastructure needed for prevention programmes such as counseling and testing, condom accessibility and AIDS information is less developed.

Acquired Immunodeficiency Syndrome↗
PubMed1998

A prospective, randomized 5-year follow-up study of functional restoration in chronic low back pain patients.

A functional restoration (FR) program, dealing with a combination of intensive physical and ergonomic training, psychological pain management, and patient education, was tested in two randomized, parallel group studies. In one of these patients following the FR program were compared with a non-treated control group (project A), and in the other with patients on two less intensive treatment programs (project B). A total of 238 chronic low back pain patients participated in the two studies, 106 entering project A and 132 project B. Patients from the two projects were comparable except that the patients in project A were recruited from all over the country, whereas patients in project B all were living in and around Copenhagen. Thirteen patients never started any treatment, and 20 patients (9%) dropped out during the treatment period. Of the 207 who completed treatment, 89% returned a mailed questionnaire 5 years later. This was the case for 55% of the drop-outs. The questions referred to work situation, pain level, activities of daily living, days of sick leave, contact with health care professionals, physical activity, use of medication, and a subjective overall assessment. The results show that in project A the treated group reported significantly fewer contacts with the health care system and significantly fewer days of sick leave over the 5-year follow-up period compared to the control group. In all other parameters, including work ability, there was no statistically significant difference between the two groups. In project B, patients treated in the FR program did significantly better in most measured parameters, except in leg pain, use of pain medication and sport activity, where no significant differences were found between groups. The overall result shows a positive long-term effect of the FR program, but it also shows the necessity of testing a given treatment in different projects and designs, among other things due to statistical variations.

Absenteeism↗
PubMed2002

SNP databases and pharmacogenetics: great start, but a long way to go.

With the recent publication of the human genome project there has been an explosion of data available for pharmacogenetic research. Web-based databases containing information on single nucleotide polymorphisms (SNPs) are readily accessible to researchers, but there has been little comment on their utility. We used seven major international databases to identify SNPs in 74 genes involved in drug pathways. Very little overlap was seen among the databases, with only eight out of a putative 893 SNPs ( approximately 1%) common to the most commonly used databases. Problems with false positives, secondary to a high degree of homology in gene families, were also observed. These studies suggest researchers limiting their studies to one database would miss a great deal of information. Effort to update compilation databases, such as HGVbase, GeneSNP, PharmGKB, and HOWDY, and the aggressive removal of false positives from all databases is required if these resources are to facilitate the intended growth in pharmacogenetics research.

Amino Acid Sequence↗
PubMed1999

APOM-project: managing change to the customer in community pharmacy practice.

In 1994, a Ph.D.-study started regarding pharmacy, organization and management (APOM) in the Netherlands. This article describes the final phase of the study in community pharmacy practice: managerial problems in change to the customer and the difference between supported pharmacy managers and independent ones. It appeared that pharmacy managers experienced problems with the formulation and use of aims, norms, and measurements. Although many organizations operating in the pharmaceutical sector are a good source for new ideas, they lack to have the proper support for these problems. The difference between supported and independent pharmacy managers was minimal in the change to the customer. Pharmacy managers are in need of micro-instrumentalization: aims, norms, and monitor instruments for customer activities applicable at their own pharmacy. Moreover, pharmacy managers will have to learn how to deal with the tension between money and care in order to improve the 'grip' on their organization.

Community Pharmacy Services↗
PubMed2005

Using policy simulation to predict drug plan expenditure when planning reimbursement changes.

BACKGROUND: Drug plan decision makers need accurate financial impact projections before the implementation of new drug policy initiatives. Tools for such projections need to have small margins of error and be based on methodology that is easy to communicate to stakeholders. Ad hoc methods typically used for financial impact projections by health plans are inadequate. OBJECTIVE: To present a flexible tool for projecting the financial impact of drug policy changes based on historical dispensing data and simulation, and explore its validity using a recent example of a complex drug policy change in British Columbia, Canada. METHODS: A policy simulator (SAS) program using a Web browser interface) was used to produce 3-year forecasts of expenditure (for the drug plan and for individual families) along with the number of patients who would pay more or less for their drugs (stratified by age and income level) for various proposed drug policies starting in 2003. Drug expenditure under each policy was simulated based on projections from prescription claim records of the British Columbia PharmaNet database of community pharmacy prescriptions from 1 January 2001 to 31 December 2001. The simulator selected a random 1% sample of British Columbia families (175,000 families) in the database. Once the new drug policy was selected and implemented, the accuracy of the predictions were tested by comparing the actual PharmaCare expenditure for the period 1 May 2003 to 31 March 2004 after implementation of the new drug policy with the final simulation made for this policy in February 2003, 2 months before the policy was implemented. RESULTS: The policy simulation tool produced hundreds of variations for decision makers in the months before the final policy rules were decided upon. When compared with actual drug expenditure after policy implementation, it was found that the tool had predicted spending with <1% error for the first 11 months after introduction of the policy. As well as producing accurate expenditure forecasts for the insurer, the tool was able to predict how family out-of-pocket expenditure would be affected. CONCLUSIONS: The simulator aided drug policy planning and communication. The tool provided rapid and accurate results that were communicated easily to decision makers. Such policy simulation can be applied to a wide range of health plans and policy changes.

Aged↗
PubMed1993

[Standardized ambulatory insulin therapy of initial moderate ketoacidosis in type 1 diabetes. A pilot project].

Most textbooks advise that newly diagnosed insulin dependent mellitus be admitted to the hospital for starting carefully insulin treatment. We report a pilot study for starting an outpatient insulin using continuous subcutaneous insulin infusion. In 40 newly IDDM (glycaemia over 16.5 mM/l, CO2 over 15 mM/l), intensive therapy was done by CSII = basal rate 1 unit/hour, bolus 5 units per meal. After a long explanatory talk (4 hours) with the physician and the nurse on hypo, hyperglycaemia, on blood glucose sensor and pump, 21 patients agreed to start insulin at home and 19 remained in hospital for 2 or 7 days. At days 3, 30 and 365, clinical and biological evaluation was done and at D30 patient education program for 5 days was undergone. Never emergency even was reported in any patient, and no difference appeared between the in and out patient in D1, D3 and D365 normalisation of blood glucose (3 days) or level cetone body (2 days) and total insulin dose. Our results suggest that outpatient is a safe and cost effective IDDM onset therapy.

Adolescent↗
PubMed2003

From immunogenetics to immunomics: functional prospecting of genes and transcripts.

Human and mouse genome and transcriptome projects have expanded the field of 'immunogenetics' beyond the traditional study of the genetics and evolution of MHC, TCR and Ig loci into the new interdisciplinary area of 'immunomics'. Immunomics is the study of the molecular functions associated with all immune-related coding and non-coding mRNA transcripts. To unravel the function, regulation and diversity of the immunome requires that we identify and correctly categorize all immune-related transcripts. The importance of intercalated genes, antisense transcripts and non-coding RNAs and their potential role in regulation of immune development and function are only just starting to be appreciated. To better understand immune function and regulation, transcriptome projects (e.g. Functional Annotation of the Mouse, FANTOM), that focus on sequencing full-length transcripts from multiple tissue sources, ideally should include specific immune cells (e.g. T cell, B cells, macrophages, dendritic cells) at various states of development, in activated and unactivated states and in different disease contexts. Progress in deciphering immune regulatory networks will require the cooperative efforts of immunologists, immunogeneticists, molecular biologists and bioinformaticians. Although primary sequence analysis remains useful for annotation of new transcripts it is less useful for identifying novel functions of known transcripts in a new context (protein interaction network or pathway). The most efficient approach to mine useful information from the vast a priori knowledge contained in biological databases and the scientific literature, is to use a combination of computational and expert-driven knowledge discovery strategies. This paper will illustrate the challenges posed in attempts to functionally infer transcriptional regulation and interaction of immune-related genes from text and sequence-based data sources.

Alternative Splicing↗
PubMed2005

Development of functional requirements for electronic health communication: preliminary results from the ELIN project.

BACKGROUND: User participation is important for developing a functional requirements specification for electronic communication. General practitioners and practising specialists, however, often work in small practices without the resources to develop and present their requirements. It was necessary to find a method that could engage practising doctors in order to promote their needs related to electronic communication. MATERIALS AND METHODS: Qualitative research methods were used, starting a process to develop and study documents and collect data from meetings in project groups. Triangulation was used, in that the participants were organised into a panel of experts, a user group, a supplier group and an editorial committee. RESULTS: The panel of experts created a list of functional requirements for electronic communication in health care, consisting of 197 requirements, in addition to 67 requirements selected from an existing Norwegian standard for electronic patient records (EPRs). Elimination of paper copies sent in parallel with electronic messages, optimal workflow, a common electronic 'envelope' with directory services for units and end-users, and defined requirements for content with the possibility of decision support were the most important requirements. CONCLUSIONS: The results indicate that we have found a method of developing functional requirements which provides valid results both for practising doctors and for suppliers of EPR systems.

Attitude of Health Personnel↗
PubMed2006

Implementing Six Sigma in The Netherlands.

BACKGROUND: Six Sigma, a process-focused strategy and methodology for business improvement, can be used to improve care processes, eliminate waste, reduce costs, and enhance patient satisfaction. EXPERIENCE WITH SIX SIGMA IN THE NETHERLANDS: Six Sigma was introduced in 2001 at the 384-bed Red Cross Hospital (Beverwijk). During the Green Belt training, every participant was required to participate in at least one Six Sigma project. The hospital's total savings in 2004 amounted to 1.4 million dollars, for an average savings of 67,000 dollars for each of the completed 21 projects. THREE EXAMPLES OF SUCCESSFUL PROJECTS: In one project, the team designed a new admission process for the operating rooms, resulting in an average starting time nine minutes earlier. This relatively minor improvement made it possible to operate on an additional 400 patients a year and to achieve a net savings of >273,000 dollars. A second project reduced the number of patients receiving intravenous (IV) antibiotics by switching to oral administration, yielding annual savings, based on medication costs alone, of >75,000 dollars. A third project reduced the length of stay in the delivery room from 11.9 to 3.4 hours, yielding an annual savings of 68,000 dollars. The "Ultimate Cure?": Six Sigma, which entails involvement of health care workers; use of improvement tools (from industry); creation of trained project teams to tackle complex, often cross-departmental processes; data analyses; and investment in quality improvement may prove the "ultimate cure" to the current cost, quality, and safety issues that challenge health care.

Anti-Bacterial Agents↗