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PubMed2005

Simulating public health response to a severe acute respiratory syndrome (SARS) event: a comprehensive and systematic approach to designing, implementing, and evaluating a tabletop exercise.

In response to recent public health threats and disasters, greater emphasis has been placed on the use of exercises and drills to improve individual performance and enhance capacity of the public health workforce. However, despite the increased application of these exercises, rigorous research regarding their appropriate development and relative effectiveness in improving public health preparedness is limited. The present study attempted to fill this void by presenting a detailed account of a comprehensive and integrated approach to developing, implementing, and evaluating a tabletop exercise designed to enhance emergency preparedness and response of public health workers. Following a comprehensive training systems model, a tabletop exercise was developed to simulate worker recognition and response to a Severe Acute Respiratory Syndrome event among public health workers in Arkansas. Forty-nine individuals participated in the tabletop exercise, including public health workers and their external partners. Results demonstrated the effectiveness of this tabletop exercise in increasing participants' competency-related knowledge and skills. The flexibility afforded by creating a standardized competency-based process can extend to other state and local health departments and provides evidence of the reciprocal relationship between research and practice needed to advance the areas of emergency preparedness training and workforce development initiatives in public health.

Competency-Based Education↗
PubMedDate not supplied

The comprehensive organizational plan: how a COP can protect and serve your health care organization.

In today's hyperturbulent and competitive health care environment, health care organizations must improve operating efficiency, reduce duplication, and compete effectively in the health care market to survive. The comprehensive organizational plan is a 5-stage development tool for health care organizations that is intended to protect and serve the health care organization in its survival efforts. Through its 5 planning stages-competitive, facilities, financial, human resources, and marketing-the comprehensive organizational plan assists the organization in optimizing the goals of cost containment, quality preservation, and universal access.

Cost Control↗
PubMed2005

Toward efficient and comprehensive measurement of the alcohol problems continuum in college students: the brief young adult alcohol consequences questionnaire.

BACKGROUND: Although a number of measures of alcohol problems in college students have been studied, the psychometric development and validation of these scales have been limited, for the most part, to methods based on classical test theory. In this study, we conducted analyses based on item response theory to select a set of items for measuring the alcohol problem severity continuum in college students that balances comprehensiveness and efficiency and is free from significant gender bias. METHOD: We conducted Rasch model analyses of responses to the 48-item Young Adult Alcohol Consequences Questionnaire by 164 male and 176 female college students who drank on at least a weekly basis. An iterative process using item fit statistics, item severities, item discrimination parameters, model residuals, and analysis of differential item functioning by gender was used to pare the items down to those that best fit a Rasch model and that were most efficient in discriminating among levels of alcohol problems in the sample. RESULTS: The process of iterative Rasch model analyses resulted in a final 24-item scale with the data fitting the unidimensional Rasch model very well. The scale showed excellent distributional properties, had items adequately matched to the severity of alcohol problems in the sample, covered a full range of problem severity, and appeared highly efficient in retaining all of the meaningful variance captured by the original set of 48 items. CONCLUSIONS: The use of Rasch model analyses to inform item selection produced a final scale that, in both its comprehensiveness and its efficiency, should be a useful tool for researchers studying alcohol problems in college students. To aid interpretation of raw scores, examples of the types of alcohol problems that are likely to be experienced across a range of selected scores are provided.

Adolescent↗
PubMed2003

Influence on lifestyle measures and five-year coronary risk by a comprehensive lifestyle intervention programme in patients with coronary heart disease.

BACKGROUND: Lifestyle measures of coronary heart disease (CHD) prevention have been overshadowed by the efficacy of drug treatments. This is particularly the case in the setting of secondary prevention where the benefits of lipid lowering, anti-platelet and anti-hypertensive drugs have been emphasised in numerous trials. Lifestyle measures address several CHD risk factors at once and are generally free of serious side effects. OBJECTIVES: The objective of the present study was to determine whether a comprehensive programme of lifestyle modification could favourably influence dietary and exercise habits in addition to smoking cessation over two years. In addition, an attempt was made to evaluate if this programme could favourably influence the five-year CHD-risk in the male population included in the study. DESIGN: A total of 197 patients with proven coronary heart disease were included and randomised to a lifestyle intervention programme or to usual care. Follow-up was after a period of two years. METHODS: Intervention comprised a low fat diet, regular exercise, smoking cessation, psychosocial support and education, delivered by nurses on the rationale for pharmacological and lifestyle measures. Usual care comprised follow-up in the routine outpatient clinic. Both groups were given the same comprehensive medication according to recent guidelines. RESULTS: Patients in the lifestyle intervention group reduced the intake of saturated fat, sugar and cholesterol (P<0.001), increased their exercise level (P<0.01) and stopped smoking (P<0.05) when compared with the usual care group. A sub-analysis of the influence of five-year CHD calculated risk in males resulted in a relative risk reduction of 22% (95% confidence intervals 9-35). Although significant, this result must be interpreted with caution due to poor statistical power and reproducibility of the method. CONCLUSIONS: In the presence of modern drug treatments for secondary cardiovascular disease prevention it remains possible through a favourable diet, exercise and smoking cessation to show an additional reduction in the five-year risk for CHD in males.

Blood Glucose↗
PubMed2004

Comprehensive pediatric human immunodeficiency virus care and treatment in Constanta, Romania: implementation of a program of highly active antiretroviral therapy in a resource-poor setting.

BACKGROUND: Relatively few human immunodeficiency virus (HIV)-infected children worldwide have access to care and treatment. The Romanian-American Children's Center, a collaborative project of a U.S. health care institution and the Romanian government, has established a comprehensive program of highly active antiretroviral therapy for children in Constanta, Romania. OBJECTIVES: To describe the design and outcomes of a program of pediatric HIV/acquired immunodeficiency syndrome (AIDS) care and treatment in a resource-poor setting. SETTING: Outpatient center providing comprehensive primary and HIV/AIDS specialty care and treatment to all known HIV-infected children living in Constanta County, Romania. OUTCOMES: As of August 2003, a total of 452 children were receiving highly active antiretroviral therapy. Therapy has been well-tolerated, with approximately 90% of children continuing to receive treatment after a median duration of follow-up of 67 weeks. Normal weight and height growth velocities have been observed among treated children. Marked decreases have been observed in rates of hospitalization and mortality. The mean change in CD4+ lymphocyte count for 173 children who have both a baseline count and at least 1 follow-up count is +284 cells/microL (P < 0.0001). CONCLUSIONS: Highly active antiretroviral therapy can be administered safely and effectively to children in a resource-poor setting, with outcomes comparable with those observed in U.S. pediatric antiretroviral clinical trials.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Women's patterns of provider use across the lifespan and satisfaction with primary care coordination and comprehensiveness.

BACKGROUND: Women have different patterns of provider use across the lifespan, but few studies have investigated women's evaluations of their primary care providers at different ages. OBJECTIVE: We sought to investigate the relationship between patterns of regular provider use and women's satisfaction with primary care across the lifespan. RESEARCH DESIGN: A sample of 1197 women ages 18 to 87 making primary health care visits was surveyed. Satisfaction with primary care in the past year was measured with a subscale the Care Coordination and Comprehensiveness subscale of the Primary Care Satisfaction Survey for Women (PCSSW). Bivariate comparisons and age stratified multivariate ordinal logistic regression models were estimated. RESULTS: Women in their early reproductive years (ages 18 to 34) are more satisfied with care coordination and comprehensiveness when their regular provider is a reproductive health specialist, primarily obstetrician gynecologist (ob/gyn) physicians. The odds of higher satisfaction are reduced with a generalist regular provider (OR = 0.38, P < 0.01), a generalist regular provider plus an ob/gyn (OR = 0.47, P < 0.05), or no regular provider (OR = 0.52, P < 0.05). The pattern of regular provider use is not significantly associated with satisfaction for women in other age categories. CONCLUSIONS: Most adult women see generalists for their primary health care, either alone or in combination with ob/gyns. Among younger women satisfaction is higher when an ob/gyn is the regular provider. Further research must consider women's perspectives on their provider use patterns and the appropriate role of ob/gyns in women's primary care across the lifespan.

Adult↗
PubMed2006

Working memory and sentence comprehension of Hong Kong Chinese children with specific language impairment.

Children with Specific Language Impairment present with delayed language development, but do not have a history of hearing impairment, mental deficiency, or associated social or behavioral problems. Non-word repetition was suggested as an index to reflect the capacity of phonological working memory. There is a paucity of such studies among Hong Kong Chinese children. This preliminary study aimed to examine the relationship between phonological working memory and Specific Language Impairment, through the processes of non-word repetition and sentence comprehension, of children with Specific Language Impairment and pre-school children with normal language development. Both groups of children were screened by a standardized language test. A list of Cantonese (the commonest dialect used in Hong Kong) multisyllabic nonsense utterances and a set of 18 sentences were developed for this study. t-tests and Pearson correlation were used to study the relationship between non-word repetition, working memory and specific language impairment. Twenty-three pre-school children with Specific Language Impairment (mean age = 68.30 months; SD = 6.90) and another 23 pre-school children (mean age = 67.30 months; SD = 6.16) participated in the study. Significant difference performance was found between the Specific Language Impairment group and normal language group in the multisyllabic nonsense utterances repetition task and the sentence comprehension task. Length effect was noted in Specific Language Impairment group children, which is consistent with the findings of other literature. In addition, correlations were also observed between the number of nonsense utterances repeated and the number of elements comprehended. Cantonese multisyllabic nonsense utterances might be worth further developing as a screening tool for the early detection of children with Specific Language Impairment.

Child↗
PubMed2005

Pulmonary embolism: comprehensive evaluation with MR ventilation and perfusion scanning with hyperpolarized helium-3, arterial spin tagging, and contrast-enhanced MRA.

PURPOSE: Development of a comprehensive magnetic resonance (MR) examination consisting of MR angiography (MRA) and MR ventilation and perfusion (MR V/Q) scan for the detection of pulmonary emboli (PE) and assessment of the technique in a rabbit model. MATERIALS AND METHODS: Reversible PE was induced by inflating a non-detachable silicon balloon in the left pulmonary artery of five New Zealand White rabbits. MR V/Q scans were obtained prior to, during, and after balloon deflation. MRA was performed during balloon inflation. MR ventilation imaging was performed after the inhalation of hyperpolarized helium-3. MR perfusion imaging was performed with Flow-sensitive Alternating Inversion Recovery with an Extra Radiofrequency pulse technique (FAIRER). High-resolution contrast-enhanced MR pulmonary angiography was used to confirm the occlusion of the pulmonary artery. All imaging was performed on a 1.5-T whole body scanner with broadband capabilities. RESULTS: High-resolution ventilation images of the lungs were obtained. No ventilation defects were detected before, during, or after resolution of simulated PE. FAIRER imaging allowed visualization of pulmonary perfusion. No perfusion defects were detected prior to balloon inflation. During balloon inflation (PE), there was decreased perfusion in the left lower lobe. After reversal of the PE, there was improved perfusion to the left lower lobe. In analogy to nuclear medicine techniques, acute PE produced a mismatched defect in the MR V/Q scan. MRA verified the occlusive filling defect in the left pulmonary artery. CONCLUSION: High-resolution MRA and MR V/Q imaging of the lung is feasible and allows comprehensive assessment of pulmonary embolism in one imaging session.

Animals↗
PubMed2006

A multi-institutional analysis of the socioeconomic determinants of breast reconstruction: a study of the National Comprehensive Cancer Network.

OBJECTIVE: To determine the rate of postmastectomy reconstruction and investigate the impact of socioeconomic status on the receipt of reconstruction. SUMMARY BACKGROUND DATA: The National Comprehensive Cancer Network (NCCN) Outcomes Project is a prospective, multi-institutional database that contains data on all newly diagnosed breast cancer patients treated at one of the participating comprehensive cancer centers. METHODS: The study cohort consisted of 2174 patients with DCIS and stage I, II, and III invasive breast cancer who underwent mastectomy at one of 8 NCCN centers. Rates of reconstruction were determined. Logistic regression analyses were used to evaluate whether socioeconomic characteristics are associated with breast reconstruction. RESULTS: Overall, 42% of patients had breast reconstruction following mastectomy. Patients with Medicaid and Medicare were less likely to undergo reconstruction than those with managed care insurance; however, there was no difference for indemnity versus managed care insurance. Homemakers and retired patients had fewer reconstructions than those employed outside the home. Patients with a high school education or less were less likely to have reconstruction than those with more education. Race and ethnicity were not significant predictors of reconstruction. CONCLUSIONS: The reconstruction rate in this study (42%) is markedly higher than those previously reported. The type of insurance, education level, and employment status of a patient, but not her race or ethnicity, appear to influence the use of breast reconstruction. Because all patients were treated at an NCCN institution, these socioeconomic differences cannot be explained by access to care.

Adult↗
PubMed2003

Comprehensive cost comparison of adult-adult right hepatic lobe living-donor liver transplantation with cadaveric transplantation.

BACKGROUND: An important long-term consideration for living-donor liver transplantation (LDLT) is the expense compared with cadaveric-liver transplantation. LDLT is a more complex procedure than cadaveric transplantation and the cost of donor evaluation, donor surgery, and postoperative donor care must be included in a cost analysis for LDLT. In this study, we compare the comprehensive cost of LDLT with that of cadaveric-liver transplantation. METHODS: All costs for medical services provided at our institution were recorded for 24 LDLT and 43 cadaveric recipients with greater than 1 year follow-up transplanted between August 1997 and April 2000. The donor costs include donors evaluated and rejected, donors evaluated and accepted, donor right hepatectomy costs, and donor follow-up costs (365 days postdonation). LDLT and cadaveric recipient costs include medical care 90 days pre-LDLT, recipient transplant costs, and recipient follow-up costs (365 days posttransplant) including retransplantation. Cost is expressed as an arbitrary cost unit (CU) that is a value between $500 to $1,500. RESULTS: Total LDLT costs (evaluations of rejected donors+evaluations of accepted donors+donor hepatectomy+donor follow-up care for 1 year+pretransplant recipient care [90 days pretransplant]+recipient transplantation+recipient 1-year posttransplant care)= 162.7 CU. Total mean cadaveric transplant costs (pretransplant recipient care [90 days pretransplant]+recipient transplantation [including organ acquisition cost]+recipient 1-year posttransplant care)= 134.5 CU, (P =ns). CONCLUSIONS: The total comprehensive cost of LDLT is 21% higher than cadaveric transplantation, although this difference is not significant.

Adult↗
PubMed2007

Whole blood RNA offers a rapid, comprehensive approach to genetic diagnosis of cardiovascular diseases.

PURPOSE: Long QT Syndrome, Marfan Syndrome, hypertrophic and dilated cardiomyopathy are caused by mutations in large, multi-exon genes that are principally expressed in cardiovascular tissues. Genetic testing for these disorders is labor-intensive and expensive. We sought to develop a more rapid, comprehensive, and cost-effective approach. METHODS: Paired whole blood samples were collected into tubes with or without an RNA-preserving solution, and harvested for whole blood RNA or leukocyte DNA, respectively. Large overlapping cDNA fragments from KCNQ1 and KCNH2 (Long QT Syndrome), MYBPC3 (hypertrophic and dilated cardiomyopathy), or FBN1 (Marfan Syndrome) were amplified from RNA and directly sequenced. Variants were confirmed in leukocyte DNA. RESULTS: All 4 transcripts were amplified and sequenced from whole blood mRNA. Six known and 2 novel mutations were first identified from RNA of 10 probands, and later confirmed in genomic DNA, at considerable savings in time and cost. In one patient with MFS, RNA sequencing directly identified a splicing mutation. Results from RNA and DNA were concordant for single nucleotide polymorphisms at the same loci. CONCLUSION: Taking advantage of new whole blood RNA stabilization methods, we have designed a cost-effective, comprehensive method for mutation detection that should significantly facilitate clinical genetic testing in four lethal cardiovascular disorders.

Adolescent↗
PubMed1994

Impairment of sentence comprehension.

We examine two different forms of comprehension impairment, 'semantic dementia' and 'asyntactic comprehension', focusing on the assignment of thematic roles; the determination of who did it to whom. We show, first, that the loss of word meaning does not impede thematic assignment in semantic dementia, demonstrating that syntactic information, along with some knowledge of the verb, is sufficient for the assignment of thematic roles. Studies of normal subjects indicate, however, that this process is normally subject to semantic influences; asked to judge the plausibility of sentences, subjects respond faster when thematic assignment is semantically constrained. The sentence plausibility judgments of 'asyntactic' comprehenders (aphasics with diminished syntactic control over thematic assignment) show increased effects of these semantic constraints. We discuss these results in relation to current issues in sentence processing.

Aphasia↗
PubMed2005

Comprehensive analysis of transcriptional promoter structure and function in 1% of the human genome.

Transcriptional promoters comprise one of many classes of eukaryotic transcriptional regulatory elements. Identification and characterization of these elements are vital to understanding the complex network of human gene regulation. Using full-length cDNA sequences to identify transcription start sites (TSS), we predicted more than 900 putative human transcriptional promoters in the ENCODE regions, representing a comprehensive sampling of promoters in 1% of the genome. We identified 387 fragments that function as promoters in at least one of 16 cell lines by measuring promoter activity in high-throughput transient transfection reporter assays. These positive functional results demonstrate widespread use of alternative promoters. We show a strong correlation between promoter activity and the corresponding endogenous RNA transcript levels, providing the first experimental quantitative estimate of promoter contribution to gene regulation. Finally, we identified functional regions within a randomly selected subset of 45 promoters using deletion analyses. These experiments showed that, on average, the sequence -300 to -50 bp of the TSS positively contributes to core promoter activity. Interestingly, putative negative elements were identified -1000 to -500 bp upstream of the TSS for 55% of genes tested. These data provide the largest and most comprehensive view of promoter function in the human genome.

Gene Expression Regulation↗
PubMed1999

A comprehensive view of human chromosome 1.

Comprehensive representations of human chromosomes combining diverse genomic data sets, localizing expressed sequences, and reflecting physical distance are essential for disease gene identification and sequencing efforts. We have developed a method (CompView) for integrating genomic information derived from available cytogenetic, genetic linkage, radiation hybrid, physical, and transcript-based mapping approaches. CompView generates chromosome representations with substantially higher resolution, coverage, and integration than current maps of the human genome. The CompView process was used to build a representation of human chromosome 1, yielding a map with >13,000 unique elements, an effective resolution of 910 kb, and a marker density of 50 kb. CompView creates comprehensive and fully integrated depictions of a chromosome's clinical, biological, and structural information.

Chromosome Mapping↗
PubMed2001

Comprehensive genome sequence analysis of a breast cancer amplicon.

Gene amplification occurs in most solid tumors and is associated with poor prognosis. Amplification of 20q13.2 is common to several tumor types including breast cancer. The 1 Mb of sequence spanning the 20q13.2 breast cancer amplicon is one of the most exhaustively studied segments of the human genome. These studies have included amplicon mapping by comparative genomic hybridization (CGH), fluorescent in-situ hybridization (FISH), array-CGH, quantitative microsatellite analysis (QUMA), and functional genomic studies. Together these studies revealed a complex amplicon structure suggesting the presence of at least two driver genes in some tumors. One of these, ZNF217, is capable of immortalizing human mammary epithelial cells (HMEC) when overexpressed. In addition, we now report the sequencing of this region in human and mouse, and on quantitative expression studies in tumors. Amplicon localization now is straightforward and the availability of human and mouse genomic sequence facilitates their functional analysis. However, comprehensive annotation of megabase-scale regions requires integration of vast amounts of information. We present a system for integrative analysis and demonstrate its utility on 1.2 Mb of sequence spanning the 20q13.2 breast cancer amplicon and 865 kb of syntenic murine sequence. We integrate tumor genome copy number measurements with exhaustive genome landscape mapping, showing that amplicon boundaries are associated with maxima in repetitive element density and a region of evolutionary instability. This integration of comprehensive sequence annotation, quantitative expression analysis, and tumor amplicon boundaries provide evidence for an additional driver gene prefoldin 4 (PFDN4), coregulated genes, conserved noncoding regions, and associate repetitive elements with regions of genomic instability at this locus.

Animals↗
PubMed2004

Comprehensive comparison of auxin-regulated and brassinosteroid-regulated genes in Arabidopsis.

Although numerous physiological studies have addressed the interactions between brassinosteroids and auxins, little is known about the underlying molecular mechanisms. Using an Affymetrix GeneChip representing approximately 8,300 Arabidopsis genes, we studied comprehensive transcript profiles over 24 h in response to indole-3-acetic acid (IAA) and brassinolide (BL). We identified 409 genes as BL inducible, 276 genes as IAA inducible, and 637 genes in total. These two hormones regulated only 48 genes in common, suggesting that most of the actions of each hormone are mediated by gene expression that is unique to each. IAA-up-regulated genes were enriched in genes regulated in common. They were induced quickly by IAA and more slowly by BL, suggesting divergent physiological roles. Many were early auxin-inducible genes and their homologs, namely SAUR, GH3, and IAA. The comprehensive comparison also identified IAA- and BL-specific genes, which should help to elucidate the specific actions of each hormone. The identified genes were classified using hierarchical clustering based on the similarity of their responses to the two hormones. Gene classification also allowed us to analyze the frequency of cis-elements. The TGTCTC element, a core element of the previously reported auxin response element, was not enriched in genes specifically regulated by IAA but was enriched in the 5'-flanking region of genes up-regulated by both IAA and BL. Such gene classification should be useful for predicting the functions of unknown genes, to understand the roles of these two hormones, and the promoter analysis should provide insight into the interaction of transcriptional regulation by the two hormones.

Arabidopsis↗
PubMed2002

A procedural evaluation of an analytic-deliberative process: the Columbia River Comprehensive Impact Assessment.

The U.S. Department of Energy's Columbia River Comprehensive Impact Assessment (CRCIA) was an ambitious attempt to direct its cleanup of the Hanford Nuclear Reservation toward the most significant risks to the Columbia River resulting from past plutonium production. DOE's approach was uncommonly open, including tribal, regulatory agency, and other Hanford interest group representatives on the board that was to develop the assessment approach. The CRCIA process had attributes of the "analytic-deliberative" process for risk assessment recommended by the National Research Council. Nevertheless, differences between the DOE and other participants over what was meant by the term "comprehensive" in the group's charge, coupled with differing perceptions of the likely effectiveness of remediation efforts in reducing risks, were never resolved. The CRCIA effort became increasingly fragmented and the role its products were to play in influencing future clean-up decisions increasingly ambiguous. A procedural evaluation of the CRCIA process, based on Thomas Webler's procedural normative model of public participation, reveals numerous instances in which theoretical-normative discourse disconnects occurred. These had negative implications for both the basic procedural dimensions of Webler's model-fairness and competence. Tribal and other interest group representatives lacked the technical resources necessary to make or challenge what philosopher Jurgens Habermas terms cognitive validity claims, while DOE and its contractors did not challenge normative claims made by tribal representatives. The results are cautionary for implementation of the analytic-deliberative process. They highlight the importance of bringing rigor to the evaluation of the quality of the deliberation component of risk characterization via the analytic-deliberative process, as well as to the analytic component.

Journal Article↗
PubMedDate not supplied

Benefits of the Comprehensive Child Development Program as a function of AFDC receipt and SES.

The benefits for children at the Pittsburgh site of the federal Comprehensive Child Development Program (CCDP) were examined as a function of family welfare status (Aid to Families with Dependent Children; AFDC) and SES. The CCDP was the largest attempt by the federal government to provide two-generation, case-managed, comprehensive services to low-income families. Participating families could set their own goals and choose services to achieve them, but relatively few services were directed specifically at children. Results showed that more Pittsburgh families in the CCDP treatment group (N = 120) left AFDC than in the control group (N = 120), consistent with results from a national evaluation of the CCDP. Children whose families were on AFDC regardless of treatment group had lower mental test scores, even after controlling for family SES, a result suggesting that AFDC receipt over and above income level was associated with poorer child mental performance. The CCDP was associated with higher children's mental scores plus improvements over time in achievement scores only for children in families who were not on AFDC, even after controlling for SES. Such parents were more likely to choose parenting and child goals and services, which in turn were associated with higher child mental scores. In contrast, parents who were on AFDC tended to choose adult-centered goals and services, which did not benefit children. Therefore, in contrast to the national evaluation, which found no benefits of the CCDP for children, these analyses showed that the CCDP did produce benefits for children whose parents were not on AFDC, who tended to choose parenting and child services.

Aid to Families with Dependent Children↗