Managed clinical network--a start.
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Delivery of Health Care↗
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A rapid assessment of heroin use in Mombasa, Kenya.
This article reports on a rapid assessment (RA) carried out in the city port of Mombasa, Kenya in March 2004 by the Omari Project to inform the scaling up of their services to heroin users. Heroin has been a street drug in Mombasa for over 25 years. From 1998, white crest, probably from Thailand, started to replace brown sugar, and there was a major shift from inhalation of the vapor ("chasing the dragon") to injecting. The Omari Project has been monitoring the heroin situation in Mombasa and treating heroin users from Mombasa since 1997. In the course of the RA, 496 heroin users were interviewed of whom 95% were men and 5% were women. A range of methods were used, including mapping of the Mombasa region, work with a key informant/guide who was a heroin user, administration of a brief questionnaire and informal interviews, and feedback of findings to other local agencies working with drug users. Respondents were from a wide range of cultural/ethnic groups, the two largest being Mijikenda and Swahili, who are indigenous to the Kenya coast. Overall, 15% of respondents had "ever injected" heroin, and 7% were current injectors (n = 37). These data indicate a shift away from injecting but also reflect the death of many established injectors, either through overdose or AIDS or hepatitis. The figure of 7% of the sample reporting being current injectors is likely to be an underestimate. Syringes were available from a number of pharmacies and most injectors reported using a syringe for 1-3 days. The majority reported injecting in a group of three or more and described risk behaviors for HIV transmission. The results of the assessment highlight the need for a range of services, including needle exchange, counseling, and referral to residential treatment programs. However, progress toward responding to the findings of the RA by establishing effective services are hampered because of legal impediments to operating needle exchange programs in Kenya.
Catchment Area, Health↗
[German Competence Network on Atrial Fibrillation (AFNET). A nationwide cooperation for better research and patient care].
The Atrial Fibrillation Competence Network is an interdisciplinary national research network funded by the Federal Ministry of Education and Research (BMBF). The aim of the network--founded in 2003--is to improve the treatment of atrial fibrillation, the most common clinically important arrhythmia of the heart. A decentralized patient registry has been established. This registry, which comprises the manifestation, diagnostics and therapy of atrial fibrillation in Germany, is being used as a data basis for epidemiologic clinical studies. Epidemiologic projects are being conducted to study, e.g., the prevalence of atrial fibrillation as well as the occurrence of complications. Four multicenter clinical trials have been started to optimize pharmacological treatments (ANTIPAF trial, Flec-SL trial), preventive pacing (BACE-PACE trial) and catheter-based ablation (GAP-AF trial). Other clinical projects are being conducted to study the risk of neurologic complications and to develop new diagnostic imaging techniques. Experimental basic research projects are focusing on different aspects of atrial remodeling in order to find out in which way the molecular mechanisms can be manipulated by new methods of treatment. First results are presented.
Atrial Fibrillation↗
[The results of a joint project of the State Department of Ukraine on the Implementation of Punishments and UNAIDS to decrease the risk of the spread of HIV in the prisons of Ukraine].
During the period of 1987-1999 altogether 7,800 cases of HIV infection were detected among the prisoners of the penitentiary institutions of the Ukraine. In 1997 the penitentiary system of the Ukraine abolished the mandatory testing and isolation of HIV-positive persons. In April 1998 the realization of measures aimed at reducing the spread of HIV infection started in the penitentiary system. The main trends in the activities aimed at the realization of the Project were information and educational work among prisoners both during investigative detention and after conviction, as well as among the personnel of penitentiary institutions; availability of condoms and disinfectants; ensuring the possibilities of voluntary testing for HIV, as well as pre- and post-test counselling.
Cooperative Behavior↗
Prevention of coronary heart disease in Finland--application of the population strategy.
The North Karelia Project was the first population-based cardiovascular disease prevention programme. Even though it achieved, as compared to the reference population, a sizeable reduction in smoking and small effect in blood pressure and serum cholesterol levels, the effect on coronary and cardiovascular mortality of the programme remains equivocal. This is mainly due to shortcomings in the original study design and unanticipated start of the national decline in coronary mortality at the same time with the programme. North Karelia Project contributed, however, to the initiation of national activities in the prevention of cardiovascular disease. These have produced a favourable trend in lipids in the whole Finnish population. The recommendations and activities by national authorities and organizations have suffered, until recently, from orientation towards screening and individual risk factors. The success in North Karelia in early 1970's in the reduction of smoking has still not occurred nationally. Further emphasis is needed in the population approach and in the integration of preventive activities into the community and legislation.
Adult↗
Defocus-gradient corrected back-projection.
Three-dimensional reconstructions of icosahedral viruses from cryoelectron microscope images have reached resolutions where the microscope depth of field is a significant resolution-limiting factor. An analytical treatment presented here shows how the depth of field limitation can be understood as an envelope function which gradually attenuates the signal, starting well before the numerical depth of field is actually reached. A simple modification to the well-known back-projection reconstruction algorithm is described, called the defocus-gradient corrected back-projection, which computationally corrects for the contrast transfer function along a defocus gradient. Computer simulations demonstrate how the algorithm effectively eliminates the depth of field limitation.
Cryoelectron Microscopy↗
Cancer epidemiology and control in Taiwan: a brief review.
Malignant neoplasm has become the leading cause of death in Taiwan since 1982. There has been a decreasing trend for cancers of the stomach and cervix uteri, while an increasing trend has been observed for cancers of the lung, liver, oral cavity, colon and rectum, breast and prostate. International comparison and migrant studies have shown an elevated risk of hepatocellular carcinoma, nasopharyngeal carcinoma and cervical neoplasia in Taiwan. The national hepatitis B vaccination program, started in July 1984, has resulted in a significant decrease in childhood hepatocellular carcinoma in Taiwan. A decrease in prevalence of cigarette smoking has been observed among middle-aged men since the control of tobacco hazards was enacted in 1997. Free mass screening of cervical neoplasia and colorectal cancer has been implemented in the national health insurance program since 1995. Project-based screening for hepatocellular carcinoma, nasopharyngeal carcinoma and breast cancer among high-risk groups was started in 1994. Most cancer patients are diagnosed by pathological examinations and treated by surgical operation, chemotherapy and radiotherapy in major teaching hospitals in Taiwan. The Taiwan Collaborative Oncology Group has been organized to assess the efficacy of various treatment modalities through multicentric clinical trials. There has been a striking increase in expenditure for medical care of cancer patients. Cancer researchers mainly sponsored by the National Science Council and Department of Health are engaged in basic, epidemiological and clinical studies on major cancers in Taiwan. Major fields of the research include cancer genomics, gene therapy, molecular epidemiology and DNA vaccine.
Delivery of Health Care↗
River contract in Wallonia (Belgium) and its application for water management in the Sourou valley (Burkina Faso).
Inspired by the experience of a river contract in Wallonia (Belgium) since 1990, the implementation of a first river contract has been initiated in a West African country, Burkina Faso. This application is not limited to a simple transposition of the Walloon model. The Burkina context calls for adaptation to the local environmental and socio-economical realities with an adequate partnership management. The importance of the mobilization around this project of institutional partners, as well as local collectivities, agricultural producers and water users in general reveals the great expectations of the actors concerning this new tool of water participative management. But will the latter be equal to the task? A first assessment has been drawn up one year after the launch. During the first year of the project, a participative diagnostic was implemented but the understanding of basic notions of water management such as 'river' (not translatable in the local language), 'watershed', 'contract' were not obvious. After the identification of functions and uses of water in the basin, an environmental survey was started. This approach allows study with the river committees of the priority actions to be developed as a first project of restoration of the gallery forest alongside the stream to fight against desertification. This project of integrated and participative management of water at sub-basin level is a concrete example of solidarity and exchange know-how between North and South in the context of a sustainable development.
Agriculture↗
Lessons learned in developing family medicine residency training programs in Japan.
BACKGROUND: While family medicine is not well established as a discipline in Japan, a growing number of Japanese medical schools and training hospitals have recently started sougoushinryoubu (general medicine departments). Some of these departments are incorporating a family medicine approach to residency training. We sought to learn from family medicine pioneers of these programs lessons for developing residency training. METHODS: This qualitative project utilized a long interview research design. Questions focused on four topics: 1) circumstances when becoming chair/faculty member; 2) approach to starting the program; 3) how Western ideas of family medicine were incorporated; and 4) future directions. We analyzed the data using immersion/crystallization to identify recurring themes. From the transcribed data, we selected representative quotations to illustrate them. We verified the findings by emailing the participants and obtaining feedback. RESULTS: Participants included: five chairpersons, two program directors, and three faculty members. We identified five lessons: 1) few people understand the basic concepts of family medicine; 2) developing a core curriculum is difficult; 3) start with undergraduates; 4) emphasize clinical skills; and 5) train in the community. CONCLUSION: While organizational change is difficult, the identified lessons suggest issues that merit consideration when developing a family medicine training program. Lessons from complexity science could inform application of these insights in other countries and settings newly developing residency training.
Academic Medical Centers↗
A violence-prevention and evaluation project with ethnically diverse populations.
The purpose of this paper is to describe some of the challenges encountered and lessons learned while providing and evaluating a violence-prevention program for and with ethnically diverse populations in child care settings. The paper discusses Safe Start, a violence prevention education program for child care staff and parents, and the evaluation of the program. Safe Start was designed to include culturally relevant content to increase cultural awareness for child care staff and parents from diverse ethnic backgrounds. The evaluation project enrolled child care centers with families representing the ethnically diverse communities in which they were located. Violence prevention research involving children from diverse ethnic backgrounds presents new methodologic challenges, but also provides new opportunities for creative, novel methods. This paper describes some of the challenges encountered with curriculum development, staff recruitment, instrument selection, and data collection procedures.
Child↗
Substance P and enkephalin containing fibers in the developing nucleus dorsalis of the human spinal cord.
A peroxidase-antiperoxidase immunostaining method was employed to determine the initial stage of appearance and localization of substance P (SP) and enkephalin (ENK) in the nucleus dorsalis of the developing human spinal cord. Both SP- and ENK-positive fibers started to appear from the 10th week of gestation in regions surrounding the nucleus dorsalis. SP-positive fibers then reached the nucleus at 13 weeks and from 26 weeks to term, three strands of SP-positive fibers, which were predominantly originated from the superficial layers of the dorsal horn, penetrated into the nucleus dorsalis from its medial, median and lateral aspects. From 26 weeks onwards, ENK-positive fibers, originated from the superficial and the adjacent layers of the spinal cord, formed a thicker medial and a thinner lateral bundle projecting into the nucleus dorsalis. Our results show that both SP- and ENK-positive fibers started to appear at around 10 weeks and a consistent pattern of immunoreactivity was established by around 26-30 weeks of gestation.
Axons↗
Recovery of vision in fish after optic nerve crush: a behavioral and electrophysiological study.
Recovery of the visual field was studied during regeneration of the retinotectal projection in bluegill sunfish (Lepomis macrochirus) using a behavioral perimetry technique. Fish were trained to orient ballistically to brief light flashes along the horizontal meridian. After crushing the right optic nerve intraorbitally, orienting to stimuli in the right visual field in different fish reappeared between 32 and 56 days postcrush. On average, recovery of the field center (30 to 150 degrees) occurred in 3 days, the most temporal 30 degrees requiring a further 7 days. Orientation accuracy, measured by the mean absolute error angle, returned to normal 10 to 15 days from the start of recovery. Perimetry was terminated at different times to 152 days postcrush, and the retinotectal projection was mapped electrophysiologically using an automated procedure to characterize multiunit receptive fields (MURFs). At early stages of visual recovery, MURFs associated with strong multiunit discharges were found in the same field regions responsive in behavioral perimetry. The 10- to 15-day recovery of normal orienting accuracy was associated with an increase in the amplitude of multiunit activity, attaining a plateau of 75% of normal. There was also evidence of a long-term decline in MURF area. Early maps showed a roughly normal visutopic order, although abnormalities in MURF size and shape persisted to as much as 152 days postcrush.
Animals↗
University of Wyoming College of Engineering undergraduate design projects to aid Wyoming persons with disabilities, a mid-program review.
In Spring 2002 the University of Wyoming received National Science Foundation funding from the Division of Bioengineering and Environmental Systems to provide a meaningful design experience for University of Wyoming, College of Engineering students that will directly aid individuals with disabilities within the state of Wyoming. At the 2003 RMBS we presented a paper on the value of starting such a program. We have found that students receive a much richer capstone design experience when developing a project for direct use by a challenged individual. We are now approximately midway through this project. Since its inception the program has blossomed to include serving individuals in several regional states, outreach short courses to the community, projects have become of increasing difficulty and involve interdisciplinary teamwork, and many challenged individuals have been provided specialized one of a kind assistive devices. In this paper we will report on these advancements, lessons learned, and benefits received by participating in this vital program.
Biomedical Engineering↗
Gene chips and arrays revealed: a primer on their power and their uses.
This article provides an overview and general explanation of the rapidly developing area of gene chips and expression array technology. These are methods targeted at allowing the simultaneous study of thousands of genes or messenger RNAs under various physiological and pathological states. Their technical basis grows from the Human Genome Project. Both methods place DNA strands on glass computer chips (or microscope slides). Expression arrays start with complementary DNA (cDNA) clones derived from the EST data base, whereas Gene Chips synthesize oligonucleotides directly on the chip itself. Both are analyzed using image analysis systems, are capable of reading values from two different individuals at any one site, and can yield quantitative data for thousands of genes or mRNAs per slide. These methods promise to revolutionize molecular biology, cell biology, neuroscience and psychiatry. It is likely that this technology will radically open up our ability to study the actions and structure of the multiple genes involved in the complex genetics of brain disorders.
DNA, Complementary↗
[Safety management activities of Yokohama City University Hospital--safety management is the platform of quality improvement].
Four years have passed since mistaking patients for operations occurred at Yokohama city university hospital (YCU hosp) on January 11, 1999. The accident was not just a simple mistake such as the patients happened to have the same name. Its root seemed to be a system error that deeply related to health care delivery at YCU hosp. Based on the trying experience, YCU hosp started to construct a new system for health care safety management. From 2001 the system development entered the second phase. The activities of this phase included promoting interdisciplinary projects on a variety of topics, implementing a systematic educational program, and activating risk managers. As a whole, autonomous activities by health care professionals regarding patient safety started to take place in the hospital as a new approach for safety management. The next step will be to expand these activities into a movement for hospital-wide quality improvement and establishing clinical governance.
Aged↗
Barriers to timely care of acute infections in nursing homes: a preliminary qualitative study.
BACKGROUND AND OBJECTIVES: During a large prospective study of lower respiratory infections in nursing home residents, project staff observed that in some facilities there was consistent difficulty in obtaining timely identification of potential subjects. Starting with this motivation, we conducted a preliminary qualitative study to investigate the process of illness identification and initiating management in episodes of acute infection. We sought factors promoting timely or delayed identification and treatment of acute infections among nursing home residents. DESIGN: Qualitative study using focus groups and in-depth semi-structured interviews of residents, nurses, and physicians involved in episodes of acute-illness care in nursing home residents. SETTING: Four nursing homes participating in a longitudinal study of the course and outcomes of lower respiratory infection. PARTICIPANTS: Focus groups included nurses and physicians with experience in nursing home care. Interviews were conducted with those involved in six episodes of acute illness. Interviewees included four nursing home residents (two others were not cognitively intact), seven nurses, and six physicians or their staff. DATA ANALYSIS: Identifying themes from focus group contributions and content analyses of interviews. RESULTS: We identified a four-stage model describing illness identification and management. Content analysis of interview transcripts revealed 22 factors that influenced timeliness of effective care with communication problems commanding the central focus. Barriers included: (1) failure of the communication medium; (2) evening or weekend illness onset with concomitant difficulty in contacting an on-call physician; (3) clinical decision-makers who interact through intermediaries; (4) the communication of inappropriate or inaccurate information; (5) inadequate information transfer at shift changes; and (6) prior relationship between staff nurse and physician. CONCLUSION: Effective identification and management of acute infections requires successful communication at multiple levels; however, breakdowns are common. Our model provides a framework for improving acute illness care in nursing homes, which offers important insights potentially useful in quality improvement activities in nursing homes and may facilitate further research.
Journal Article↗
Cancer gene discovery using digital differential display.
The Cancer Gene Anatomy Project database of the National Cancer Institute has thousands of expressed sequences, both known and novel, in the form of expressed sequence tags (ESTs). These ESTs, derived from diverse normal and tumor cDNA libraries, offer an attractive starting point for cancer gene discovery. Using a data-mining tool called Digital Differential Display (DDD) from the Cancer Gene Anatomy Project database, ESTs from six different solid tumor types (breast, colon, lung, ovary, pancreas, and prostate) were analyzed for differential expression. An electronic expression profile and chromosomal map position of these hits were generated from the Unigene database. The hits were categorized into major classes of genes including ribosomal proteins, enzymes, cell surface molecules, secretory proteins, adhesion molecules, and immunoglobulins and were found to be differentially expressed in these tumorderived libraries. Genes known to be up-regulated in prostate, breast, and pancreatic carcinomas were discovered by DDD, demonstrating the utility of this technique. Two hundred known genes and 500 novel sequences were discovered to be differentially expressed in these select tumor-derived libraries. Test genes were validated for expression specificity by reverse transcription-PCR, providing a proof of concept for gene discovery by DDD. A comprehensive database of hits can be accessed at http:// www.fau.edu/cmbb/publications/cancergenes. htm. This solid tumor DDD database should facilitate target identification for cancer diagnostics and therapeutics.
Biological Specimen Banks↗
Projection of the lumbar pedicle and its morphometric analysis.
STUDY DESIGN: This study defined the projection point of the lumbar pedicle on its posterior aspect and its relation to a reliable landmark and reported pedicle dimensions based on 50 lumbar spines. OBJECTIVES: To establish the best starting point for a pedicle screw for passing the screw down the center (axis) of the pedicle; to describe quantitatively the relations of the pedicle projection point to a reliable landmark; and to evaluate the linear and angular dimensions of the lumbar pedicle. SUMMARY OF BACKGROUND DATA: Posterior transpedicular screw fixation has been most widely used for management of the unstable lumbar spine. Several studies of pedicular anatomy exist, but little quantitative data regarding the location of the lumbar pedicle axis for each level have been reported. METHODS: Fifty dry lumbar specimens (250 lumbar vertebrae) were obtained for study of the lumbar pedicle. Anatomic evaluation focused on determination of the projection point of the lumbar pedicle axis on the junction of the superior facet and the transverse process and measured the distance from the projection point to the midline of the transverse process for each level of the lumbar vertebrae. Pedicle dimensions, including linear and angular, also were measured. RESULTS: Differences in dimensions between men and women were not found to be statistically significant. The average distance from the projection point to the midline of the transverse process consistently changed from L1 to L5. Above L4, the projection point for men and women averaged 3.9 mm for L1, 2.8 mm for L2, and 1.4 mm for L3 superior to the midline of the transverse process, respectively. At L4, the projection point was close to the midline of the transverse process (0.5 mm inferior). At L5, the projection point was an average of 1.5 mm inferior to the midline of the transverse process. CONCLUSIONS: The average distance from the projection point of the lumbar pedicle axis to the midline of the transverse process consistently varied at different levels. This information may prove helpful in the placement of screws into the lumbar pedicle.
Adult↗