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PubMedDate not supplied

PVO / NGO initiatives, Asia. Karmajibi Kallyan (KKS), Bangladesh and Save the Children Fund Australia (SCFA).

Karmajibi Kallyan (KKS) and Save the Children Fund Australia (SCFA) are implementing a program that integrates HIV/AIDS prevention and income generation activities aimed at the pre-adolescent girl servants of commercial sex workers in the Rajbari district of Bangladesh. The initial objectives of the program were to identify and establish alternative income generating activities for 150 girl servants; provide literacy education to these girls based on such topics as primary health care (HIV/AIDS prevention), credit, and small business management; and promote HIV/AIDS awareness in the wider community. Since implementation, the program has adjusted its objectives in order to meet the needs of the community. Many of the girls are much younger than the project originally planned for--most are only 7 or 8 years old--therefore, KKS and SCFA have begun identifying income generation possibilities for their mothers and encouraging the girls to focus on their education. They are also hoping to expand their literacy programs to other children in the community. For more information, please contact HIDNA (HIV/AIDS and International Development Network of Australia), ACFOA, Private Bag 3, Deakin ACT 2600, Australia; tel: +61 6 285 1816; fax: +61 6 285 1720; e-mail: acfoa@peg.apc.org. (ECHIDNA, Bulletin No. 5, September 1995)

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Intensive inpatient treatment of young adult chronic patients.

Young adults with chronic mental disorders have become a major concern among mental health professionals during the past decade. Many of these patients require frequent hospitalizations, are noncompliant with treatment, experience behavioral crises that threaten themselves or others, abuse drugs and alcohol, and alienate their families and support systems. The authors describe an intensive inpatient program for young adult chronic patients who have repeatedly failed to respond to community-based and standard state hospital care and appear to need extended institutional care. The program, which integrates psychiatric and rehabilitation strategies, has succeeded in increasing the amount of time these patients remain in the community. Although the goal for such patients remains a community-based treatment program, the value of an extended period of active inpatient treatment for some patients may be overlooked in current planning for them.

Adult↗
PubMedDate not supplied

Nonlinear waveform generation.

We developed three analog logic SPICE (Simulation Program with Integrated Circuit Emphasis, developed at the University of California, Berkeley, CA) subcircuits, a voltage comparator and a nonlinear waveform generator to compliment the previously derived functions (Goldstein and Rypins, Comput. Methods Programs Biomed. 29 (1989) 161-172) that simplify modeling of physiologic systems. The logic elements are the 'AND', 'OR' and 'NOT' Boolean functions. In addition, we derived a voltage comparator for use in our composite waveform generator. All the circuits are analog so they can be incorporated into existing analog circuits while performing digital functions.

Analog-Digital Conversion↗
PubMed1998

Innovation in two alternative elementary school programs: why it works.

The purpose of this paper was to describe and interpret the factors that supported and maintained curricular innovation at two alternative elementary schools. The two schools have Project Adventure as their curriculum focus and use the concepts of risk, challenge, trust, cooperation, and problem solving; briefing and debriefing; and personal goal-setting contracts as part of their schoolwide curriculum (Project Adventure, 1991). Data were collected through formal interviews with the physical education teachers, the principals, and four classroom teachers at each school. Nonparticipant observation, field notes, informal interviews, and document analysis were also conducted. Inductive analysis and constant comparison were used to analyze and organize the data throughout the research process. Five factors emerged that supported the implementation of this innovative physical education program: a shared vision, external support for the schools' programs, curricula integration, centrality of physical education, and shared decision making. Project Adventure at these schools provides an example of substantive curricular reform where physical education was a critical element in the school programs.

Child↗
PubMed2004

[Financing healthcare in low-income countries: recurring questions, new challenges].

Healthcare financing policies in low-income countries have gone through three successive phases. In the first phase the dominant approach was based on free access to healthcare and focused first on development of vertical programs and then on the necessity of providing primary care to all. While maintaining the emphasis on accessibility to primary care, the second policy phase introduced user fees and attempted to integrate healthcare programs into district-based healthcare structures. The third phase has been strongly influenced by the relationship between healthcare and development and the Millenium Objectives and places strong emphasis on necessity of developing insurance schemes. Recent studies on the relationship between healthcare spending and health status indicate that the efficiency and effectiveness of healthcare spending plays a more determinant role than the amount. At the same time an effort is being made to develop synergy between the different players in the health care systems and to clarify the role of each player by hinging financing decisions on operating criteria such as "public welfare", externalities, catastrophic costs, and equity. Although many countries have made significant progress, there are still several lagging areas, i.e., coverage for the poorest segment of the population (despite the rhetoric), follow-up of financing, and governance. Increasing external aid already initiated by several states may have a non-negligible impact on the macroeconomic balance. Since these changes could lead to adverse effects on health, there is a need to implement careful non-dogmatic policies.

Decision Making↗
PubMedDate not supplied

Evaluating the treatment integrity of a continuing education program.

Effective Patient Teaching (EPT), a health profession continuing education course, improves educators' teaching skills. The authors, through this dissemination study, aimed to learn whether, through a train-the-trainers approach, others could teach Effective Patient Teaching as its developers intended--that is, the assessment of what has been called "treatment integrity." Trainers' overall fidelity within and between three test sites was good, supporting Effective Patient Teaching's generalizability and transportability.

Education, Nursing, Continuing↗
PubMed2006

Evaluation of "depression in primary care" innovations.

Key stakeholders and executive decision makers in health care system require clear and convincing data of the value of chronic illness care models for the primary care treatment of depression. Well-conceived and conducted evaluations provide this necessary information. This case study describes the experience of a large, nonprofit health care system's experience with implementing and evaluating a quality improvement program for integrating depression management into primary care. The commentary that follows discusses specific evaluation questions that are relevant to each of the stakeholder groups involved in deciding whether or not to continue supporting such programs.

Depression↗
PubMed1996

[School at the end of life. What objectives what hope?].

BACKGROUND: School intervention programs for children and adolescents with cancer have been developed in France during the last years. Their primary objective is to improve the pschychosocial adaptation of these children to normal life through school integration. These programs are however inadequate for these children who will ultimately die from their disease and may require a specific school intervention. MATERIAL AND METHODS: School data from 30 children requiring palliative care were prospectively collected. School interest, its evolution and specific adaptations according to the child's status were analysed. RESULTS: Sixty per cent of the children showed a continuous desire for school education throughout their life's end. Reading, mathematics and computer work were the most favorite topics. Physical disability and fatigue may change their request during the evolution of the disease. School refusal occurred in 40% of the children and is mainly due to other extra-academic topics, or related to uncontrolled pain. CONCLUSION: Objectives of life's end school are different from educational programs proposed for children with cancer. They must be part of palliative care and have to be defined as a specific entity.

Adolescent↗
PubMed2000

Physician responsibility for removal of implants: the case for a computerized program for tracking overdue double-J stents.

PURPOSE: Ureteral stents are used in various modern urologic procedures. Although forgotten double-J (JJ) stents are an infrequent problem, they are associated with significant medical problems. Encrustation from excessive indwelling time increases morbidity and may require extracorporeal shock wave lithotripsy to free the coils of the cementing calcerous material. An effective system should be in place to ensure timely removal. The previously used "card" system not only is difficult to manage but has proved unreliable. We describe a computerized program that tracks JJ stents and alerts physicians about stents that need removal. MATERIALS AND METHODS: Two hundred eighteen patients who were stented between January 1997 and December 1998 were tracked through an integrated computerized program. This program keeps a log of all patients who received a JJ stent and determines the last date by which it should be removed. Patients are reminded if they have not returned for removal of the implant 2 weeks before it is overdue. RESULTS: Two hundred twenty-five JJ stents were placed in 218 patients. Comparison of data between the periods before and after computer program inception showed that the incidence of stents retained longer than their expiration time decreased from 12.5% to 1.2% in the first year of the program and 1.5% in the second year of the program. CONCLUSIONS: Forgotten implants pose a significant management dilemma for physicians. Our tracking program significantly lowered the incidence of overdue JJ stents from 12.5% to 1.2% and 1.5% in the first and second years, of the program respectively (p = .00039). We propose that this technically simple program should be in place for all implants placed in patients. The problems we encountered in the smooth running of this system could be averted by incorporating several recommendations.

Adolescent↗
PubMed1983

[Social cost effectiveness of 2 systems of treatment of malnourished children, in Chile].

Two approaches in the care of malnourished children were evaluated in order to ascertain both their medical and economical effectiveness. One was a group of 745 children under an ambulatory nutritional rehabilitation program that included health care, supplementary foods and nutrition education; a second group of 420 children attended Day Care Centers (8 hours a day and five days per week) where they received a balanced diet, psychomotor stimulation according to age, and health care. The evolution of nutritional status was followed up and plotted against the NCHS/WHO weight-for-height tables. The rate of recovery was unsatisfactory; below 50% in mild cases of malnutrition, and even less in the more severe cases. The average length of time for attaining normality was longer for moderate malnutrition and for the ambulatory program. When the calculation included a correction for the probability of recovery for each system, the advantage of the Day Care Centers became even more evident: the mean length of time for recovery was 33.2% less than the ambulatory program. The social cost per child, per day, was substantially lower in the ambulatory program. The integral calculus of social cost per child, per day, and the corrected mean time for recovery provided the social cost-effectiveness of nutritional recovery. This figure was clearly adventageous for the ambulatory program for all ages and degrees of malnutrition, exception made for moderately malnourished children below two years of age. In this case, the Day Care Centers appeared to be the most effective therapeutic alternative. This type of analysis is a contribution to the evaluation of medico-social programs for the recuperation of malnutrition. The advantage lies in the fact that it allows an optimization in the allocation of resources, when the previous step is the choice of best therapeutic alternative based upon the patient's age and nutritional status.

Ambulatory Care↗
PubMed1983

A community program in primary care for control of cardiovascular risk factors: steps in program development.

A community program for the control of cardiovascular risk factors, the CHAD program, was integrated into the primary care system of a family practice in Jerusalem. The steps used in introducing a community orientation in primary health care are used as a basis for description of the program. In the preliminary steps cardiovascular diseases and their risk factors were defined as the priority for the adult population of the community. Community diagnosis was undertaken to serve as a baseline for program content and evaluation. Planning for intervention included setting up objectives and planning strategies using standardized guidelines, and preparation of the staff and the community. Methods of implementation and surveillance are described. Two examples of evaluation of the program are cited.

Adult↗
PubMed1991

A comparison of hospital-integrated and freestanding ambulatory-surgery programs. Their uses of selected procedures.

For a variety of good reasons, the use of ambulatory surgery in the U.S. grew significantly during the 1980s. Both hospital-integrated and freestanding outpatient programs were developed, although a general lack of research on ambulatory surgery has not confirmed either approach's impact. Using the programs of Syracuse, New York, the author compares the two programs' volumes of procedures performed and each program's standing within the entire ambulatory-surgery community.

Ambulatory Surgical Procedures↗
PubMed2006

Treating homeless clients with severe mental illness and substance use disorders: costs and outcomes.

This study compared the costs and outcomes associated with three treatment programs that served 149 individuals with dual disorders (i.e., individuals with co-occurring severe mental illness and substance use disorders) who were homeless at baseline. The three treatment programs were: Integrated Assertive Community Treatment (IACT), Assertive Community Treatment only (ACTO), and standard care (Control). Participants were randomly assigned to treatment and followed for a period of 24 months. Clients in the IACT and ACTO programs were more satisfied with their treatment program and reported more days in stable housing than clients in the Control condition. There were no significant differences between treatment groups on psychiatric symptoms and substance use. The average total costs associated with the IACT and Control conditions were significantly less than the average total costs for the ACTO condition.

Adolescent↗
PubMed2003

RAPTOR: optimal protein threading by linear programming.

This paper presents a novel linear programming approach to do protein 3-dimensional (3D) structure prediction via threading. Based on the contact map graph of the protein 3D structure template, the protein threading problem is formulated as a large scale integer programming (IP) problem. The IP formulation is then relaxed to a linear programming (LP) problem, and then solved by the canonical branch-and-bound method. The final solution is globally optimal with respect to energy functions. In particular, our energy function includes pairwise interaction preferences and allowing variable gaps which are two key factors in making the protein threading problem NP-hard. A surprising result is that, most of the time, the relaxed linear programs generate integral solutions directly. Our algorithm has been implemented as a software package RAPTOR-RApid Protein Threading by Operation Research technique. Large scale benchmark test for fold recognition shows that RAPTOR significantly outperforms other programs at the fold similarity level. The CAFASP3 evaluation, a blind and public test by the protein structure prediction community, ranks RAPTOR as top 1, among individual prediction servers, in terms of the recognition capability and alignment accuracy for Fold Recognition (FR) family targets. RAPTOR also performs very well in recognizing the hard Homology Modeling (HM) targets. RAPTOR was implemented at the University of Waterloo and it can be accessed at http://www.cs.uwaterloo.ca/~j3xu/RAPTOR_form.htm.

Algorithms↗
PubMedDate not supplied

Maternal-child health and family planning: user perspectives and service constraints in rural Bangladesh.

This article presents a microanalysis of interactions between female fieldworkers and women in rural Bangladesh, and a discussion of the broader organizational constraints that hamper service delivery. It is argued that the fieldworker, herself a rural woman, is faced with considerable demand for both maternal-child health (MCH) and reproductive health care services, but that operational constraints prevent her from realizing her potential in both of these areas. Qualitative data show that, in the eyes of rural women, contraceptive use and health care are intricately intertwined, and that this association often raises a range of questions that the worker cannot address competently. A number of specific operational barriers--worker densities, staff motivation, supervision, technical competence, supplies--are identified. These barriers reflect a general institutional weakness in the Ministry of Health bureaucracy that prevents it from organizing itself to deliver user-oriented health and family planning services while maintaining adequate and appropriate standards of care.

Bangladesh↗
PubMed2005

The UCSD Research Associate Program: a recipe for successfully integrating undergraduates with emergency medicine research.

Previous reports have documented the successful integration of undergraduates into the Emergency Department (ED) to assist in data collection for various research projects, with resultant improvements in departmental academic productivity. These reports have not detailed the exact procedures required to institute such a program. Over 100 undergraduates from three institutions currently participate in the UCSD Research Associate Program. Here we document our experience with the inception of such a program and define the various components required to successfully conduct an ED undergraduate research associate program, defining the roles of key personnel, detailing the administrative component, discussing the selection of appropriate research projects and the design of data and instruction sheets, addressing issues related to training and didactics, and suggesting strategies for recruitment and upkeep of interest.

California↗