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[Follow-up observation on relapse of smear negative pulmonary tuberculosis after short-course chemotherapy].

OBJECTIVES: To evaluate the efficacy of the tuberculosis (TB) control project supported by WPRO/WHO in Jiangsu province, China, and to analyze the factors associated with relapse. METHODS: All registered patients with smear positive pulmonary tuberculosis which were diagnosed and cured in the project, were examined for bacteriological relapse after 2 to 3 years. The relationships among relapse rate, bacterial load and the time of sputum negative conversion were analyzed by historical cohort study. RESULTS: Fifty seven cases of 1,730 patients who were followed for 2 - 3 years were found smear positive, the relapse rate being 3.29%. The relapse rates in patients whose sputum became negative within two months, within three months and beyond three months after the start of therapy were 2.1%, 5.3% and 8.8% (P < 0.01), respectively. CONCLUSIONS: The long-term result of the TB control project in Jiangsu was good. The relapse rates in patients whose sputum converted negative within three months and beyond three months after the start of therapy were significantly higher than that in patients whose sputum converted negative within two months.

Antitubercular Agents↗

The greater Denver Latino Cancer Prevention/Control Network. Prevention and research through a community-based approach.

The Latino/a Research & Policy Center (LRPC), at the University of Colorado (UC) at Denver and Health Sciences Center built the Greater Denver Latino Cancer Prevention Network, a successful cancer prevention network, in 6 Denver metro area counties. The Network consisted of 23 Latino community-based organizations, health clinics, social service agencies, faith-based groups, and employee-based organizations; 2 migrant health clinics; and 14 scientific partners including the UC Comprehensive Cancer Center, the Colorado Department of Public Health and Environment, and the American Cancer Society. The Network focused on 5 significant cancers: breast, cervical, lung, colorectal, and prostate cancer. The Steering Committee initiated a review process for junior researchers that resulted in 5 NCI-funded pilot projects. Pilot projects were conducted with various Latino populations. The Network developed community education and health promotion projects including the bilingual outreach play The Cancer Monologues. The Network's partnership also started and held 2 annual health fairs, Dia de la Mujer Latina/Day of the Latina Woman, and annual health prevention summits. The Special Population Network (SPN) adapted and revised a clinical trials education outreach module that reached Network community partners. SPN partners recruited Latino/a students to cancer research through a6-week NCI training program held yearly at the UCHSC campus. The Network methodology of bringing together the Latino community with the scientific community increased the level of awareness of cancer in the Latino community and increased cancer research and the level of engagement of the scientific partners with the Latino community. Cancer 2006. (c) 2006 American Cancer Society.

Biomedical Research↗

In vitro studies of growth cone behavior support a role for fasciculation mediated by cell adhesion molecules in sensory axon guidance during development.

Axonal interactions, which are mediated by cell adhesion molecules (CAMs) as well as other types of membrane proteins, are important for sensory axon pathfinding in the developing chick hindlimb. We have previously shown that injection of antibodies that block the function of either G4/L1 or N-cadherin into the limb, starting when the first sensory axons reach the plexus, alters the segmental pattern of projections along cutaneous nerves. Specific removal of polysialic acid from NCAM using the enzyme endoneuraminidase N (Endo N) also resulted in significant changes in cutaneous projection patterns, while injection of antibodies against NCAM itself had no obvious effect (M. G. Honig and U. S. Rutishauser, 1996, Dev. Biol. 175, 325-337). To help understand the cellular basis for these findings, we developed a tissue culture system in which the axons from dorsal root ganglion explants grow within defined laminin lanes and examined whether the same treatments increased or decreased a growth cone's tendency to be closely associated with neighboring axons. After 2 days in culture, images of the cultures were recorded, antibodies or Endo N was added, and images of the same fields were recaptured an hour later. To quantify the results, growth cones located in defined regions of the laminin lanes were classified, before and after the perturbation, as "free" (i.e., growing primarily on the laminin substratum), "fasciculated" (i.e., growing tightly along other neurites), or "intermediate" (i.e., growing both on the laminin substratum and in contact with other neurites). We found that anti-G4/L1 and anti-N-cadherin, but not anti-NCAM, caused an increase in defasciculated growth cones, whereas Endo N resulted in an increase in fasciculated growth cones. These changes in fasciculation are consistent with the changes in cutaneous projections seen in our previous in ovo perturbations. The results from these tissue culture experiments thus provide strong support for the idea that one mechanism by which CAMs affect sensory axon pathfinding in vivo is by regulating the affinity of sensory growth cones for neighboring axons, which in turn can modulate the growth cone's ability to navigate through the surrounding environment.

Animals↗

An economic comparison of risperidone and olanzapine use within an integrated managed mental health program.

This study assessed differences in total mental health care costs for 1 year following initiation of risperidone or olanzapine in individuals within NorthSTAR, an integrated managed mental health pilot project. A retrospective database analysis of individuals with schizophrenia or schizoaffective disorder and newly started on either agent was conducted. Antipsychotic medication costs were significantly lower for individuals prescribed risperidone than olanzapine (1763 dollars versus 2582 dollars; p<0.001). Individuals prescribed risperidone had lower (but not significant) expenditures for mental health services (4714 dollars versus 5077 dollars; p=0.792), as well as total mental health care costs (7407 dollars versus 9011 dollars; p=0.255).

Antipsychotic Agents↗

Modeling malaria vaccines. I: New uses for old ideas.

Starting from a modification of the model of malaria transmission developed for the Garki project, this paper develops a model containing variables relevant to the stimulation of malaria vaccination programs. Modifications include (1) integration of maintenance of immunity dependent on boosting and the possibility of loss of immunity; (2) introduction of a boosting factor distinct from susceptibility to infection; (3) reinterpretation of the epidemiological compartments of positive immunes and nonimmunes in terms of severity of disease rather than just infection; (4) interpretation of the different stage-specific levels of immunity; (5) discrimination between different susceptibilities for the immune and nonimmune classes; (6) reformulation of the expression for acquisition of immunity to be biologically more acceptable. Simulations using the Garki model, Nedelman's modification of it, and our Basic model compare the similarities and differences in the predictive behavior of the models. Simulations using the Basic model reproduce observed periodic fluctuations of malaria attributed to the interplay of transmission-blocking immunity and loss of immunity in the absence of boosting in areas of unstable malaria transmission.

Animals↗

Morphometric analysis of sonographic images by spatial geometric modeling.

A methodology able to derive spatial geometric models from input sequences of sonographic slices is proposed. The developed modeling procedure can be utilized to perform computer-assisted anatomic 3D analysis both on all echo space and selected subregions. The modeling procedure is mainly composed of three sequential phases: a) automatic acquisition and preprocessing of time sequences of 2D echotomograms; b) 3D reconstruction of images and computing of discrete distance maps of selected echoes according to predefined projective laws; and c) generation of a spatial geometric model of the examined object starting from the previously computed maps.

Algorithms↗

Human tooth movement in response to continuous stress of low magnitude.

Conventional orthodontic therapy often uses force magnitudes in excess of 100 g to retract canine teeth. Typically, this results in a lag phase of approximately 21 days before tooth movement occurs. The current project was undertaken to demonstrate that by using lower force magnitudes, tooth translation can start without a lag phase and can occur at velocities that are clinically significant. Seven subjects participated in the 84-day study. A continuous retraction force averaging 18 g was applied to 1 of the maxillary canines, whereas a continuous retraction force averaging 60 g was applied to the other. The magnitude was adjusted for each canine to produce equivalent compressive stresses between subjects. Estimated average compressive stress on the distal aspect of the canine teeth was 4 kPa or 13 kPa. The moment-to-force ratios were between 9 and 13 mm. Tooth movement in 3 linear and 3 rotational dimensions was measured with a 3-axis measuring microscope and a series of dental casts made at 1- to 14-day intervals. The results showed a statistical difference in the velocity of distal movement of the canines produced by the 2 stresses (P =.02). The lag phase was eliminated and average velocities were 0.87 and 1.27 mm/month for 18 and 60 g of average retraction force. Interindividual velocities varied as much as 3 to 1 for equivalent stress conditions. It was concluded that effective tooth movement can be produced with lower forces and that because loading conditions were controlled, cell biology must account for the variability in tooth velocities measured in these subjects.

Adolescent↗

Birds of prey as limiting factors of gamebird populations in Europe: a review.

Whether predators can limit their prey has been a topic of scientific debate for decades. Traditionally it was believed that predators take only wounded, sick, old or otherwise low-quality individuals, and thus have little impact on prey populations. However, there is increasing evidence that, at least under certain circumstances, vertebrate predators may indeed limit prey numbers. This potential role of predators as limiting factors of prey populations has created conflicts between predators and human hunters, because the hunters may see predators as competitors for the same resources. A particularly acute conflict has emerged over the past few decades between gamebird hunters and birds of prey in Europe. As a part of a European-wide research project, we reviewed literature on the relationships between birds of prey and gamebirds. We start by analysing available data on the diets of 52 European raptor and owl species. There are some 32 species, mostly specialist predators feeding on small mammals, small passerine birds or insects, which never or very rarely include game animals (e.g. hares, rabbits, gamebirds) in their diet. A second group (20 species) consists of medium-sized and large raptors which prey on game, but for which the proportion in the diet varies temporally and spatially. Only three raptor species can have rather large proportions of gamebirds in their diet, and another seven species may utilise gamebirds locally to a great extent. We point out that the percentage of a given prey species in the diet of an avian predator does not necessarily reflect the impact of that predator on densities of prey populations. Next, we summarise available data on the numerical responses of avian predators to changing gamebird numbers. In half of these studies, no numerical response was found, while in the remainder a response was detected such that either raptor density or breeding success increased with density of gamebirds. Data on the functional responses of raptors were scarce. Most studies of the interaction between raptors and gamebird populations give some estimate of the predation rate (per cent of prey population taken by predator), but less often do they evaluate the subsequent reduction in the pre-harvest population or the potential limiting effect on breeding numbers. The few existing studies indicate that, under certain conditions, raptor predation may limit gamebird populations and reduce gamebird harvests. However, the number and extent of such studies are too modest to draw firm conclusions. Furthermore, their geographical bias to northern Europe, where predator-prey communities are typically simpler than in the south, precludes extrapolation to more diverse southern European ecosystems. There is an urgent need to develop further studies, particularly in southern Europe, to determine the functional and numerical responses of raptors to gamebird populations in species and environments other than those already evaluated in existing studies. Furthermore, additional field experiments are needed in which raptor and possibly also mammalian predator numbers are manipulated on a sufficiently large spatial and temporal scale. Other aspects that have been little studied are the role of predation by the non-breeding part of the raptor population, or floaters, on the breeding success and survival of gamebirds, as well as the effect of intra-guild predation. Finally there is a need for further research on practical methods to reduce raptor predation on gamebirds and thus reduce conflict between raptor conservation and gamebird management.

Animals↗

Do position and soft tissue affect distraction vector? An in vitro investigation.

OBJECTIVES: The purpose of this investigation was to provide an in vitro evaluation of the effects of soft tissue and position on vector during distraction. MATERIALS AND METHODS: A polyurethane skull and mandible replica (Synbone, Landquart, Switzerland) was used in this study along with an internal distraction device (Synthes Maxillofacial, Paoli, PA). The first portion of the investigation evaluated the effects of distractor position (inferior body, midbody, and superior body) on distraction vector. The second portion of the investigation used polyethylene straps to simulate the suprahyoid muscles and muscles of mastication, and polysulfide to simulate periosteum and mucosa. A laser light source attached to the synthetic mandible was projected on a grid 7.1 m from the construct to measure deflection from the starting point. The distractor was advanced 8.0 mm for each trial. Five trials each for inferior, middle, and superior, with and without simulated soft tissues (N = 30) were performed. Vertical and horizontal deflection along with absolute distance were measured and recorded. Means and standard deviations were derived for groups, and compared for statistical significance (P <.05) with a 1-way analysis of variance for the effects of position with and without simulated soft tissue, and with a paired t-test for the effects of simulated soft tissue within groups of similar distractor position. RESULTS: Statistically significant differences (P <.05) for distractors without simulated soft tissues were only noted for vertical deflection between the inferior and superior distractor groups. Statistically significant differences were noted for all measures, for all distractor positions with simulated soft tissues. Statistically significant differences were noted for all measures between similar distractor positions with and without simulated soft tissues. Distractors without simulated soft tissues were deflected lateral to the y-axis and above the x-axis. Distractors with simulated soft tissues were deflected lateral to the y-axis, but below the x-axis. For distractors with simulated soft tissues, the closer to the inferior border, the less the deflection from the x-axis. CONCLUSION: Position alone had minimal effects on distraction vector. Simulated soft tissues affected the vector of distraction. The combination of position and simulated soft tissues affected distraction vector.

Analysis of Variance↗

Therapeutic and economic impact of a modern amputation program.

The experience with 142 below-knee amputations for vascular occlusive disease and/or diabetes mellitus in 133 patients has been reviewed. The program utilized Xenon(133) skin bloodflow measurement for the selection of amputation level, emphasized the use of the long posterior skin flap as an important part of surgical technique, and employed immediate postoperative prosthesis with accelerated rehabilitation for postoperative management. The results of this program yielded a 0% postoperative mortality, 89% amputation healing, and 100% prosthesis rehabilitation of all unilateral below-knee amputees, and 93% rehabilitation of all bilateral below-knee amputees. The average time interval between amputation and fitting of a permanent prosthesis was 32 days. The use of Xenon(133) clearance as a measurement of capillary skin bloodflow for purposes of amputation level selection continues to be valid. All amputations with flows in excess of 2.6 ml/100 g tissue/min healed primarily, including the last 58 consecutive amputations. The total amputation of the 172 hospital V.A. system was surveyed and a cost analysis, based upon duration of postamputation hospitalization, comparing immediate postoperative prosthesis with conventional techniques, was performed. The savings to the system, taking into account start-up and maintenance costs for a program which employs immediate postoperative prosthesis, was projected to be $80,000,000 over five years. We conclude that a modern amputation program employing Xenon(133) clearance for amputation level selection and immediate postoperative prosthesis with accelerated rehabilitation is well justified based upon reduced morbidity, negligable mortality, and optimum patient prosthetic rehabilitation at a marked reduction in overall cost.

Adult↗

Improved final height in girls with Turner's syndrome treated with growth hormone and oxandrolone.

The spontaneous growth process in Turner's syndrome is characterized by a progressive decline in height velocity during childhood and no pubertal growth spurt. Therefore, therapy aimed at improving height during childhood as well as increasing final height is desirable for most girls with Turner's syndrome. Forty-five girls with Turner's syndrome, 9-16 yr of age (mean age, 12.2 yr), were allocated to three study groups. Group 1 (n = 13) was initially treated with oxandrolone alone; after 1 yr of treatment, GH without (group 1a; n = 6) or with (group 1b; n = 7) ethinyl estradiol was added. Group 2 (n = 17) was treated with GH plus oxandrolone. Group 3 (n = 15) was treated with GH, oxandrolone, and ethinyl estradiol. The dosage were: GH, 0.1 IU/kg.day; oxandrolone, 0.05 mg/kg.day; and ethinyl estradiol, 100 ng/kg.day. A height of 150 cm or more was achieved in 61%, 75%, and 60% of the girls in groups 1, 2, and 3, respectively. The most impressive increase in height was seen in group 2. In this group the mean final height was 154.2 cm (SD = 6.6), which is equivalent to a mean net gain of 8.5 cm (SD = 4.6) over the projected final height. In group 3, in which ethinyl estradiol was included from the start of therapy, the initially good height velocity decelerated after 1-2 yr of treatment. Their mean final height was 151.1 (SD = 4.6) cm, equivalent to a mean net gain of 3.0 cm (SD = 3.8). A similar growth-decelerating effect of ethinyl estradiol was seen in group 1b. We conclude that in girls with Turner's syndrome who are older than 9 yr of age, treatment with GH in combination with oxandrolone results in significant growth acceleration, imitating that in normal puberty, leading to a more favorable height during childhood. This mode of treatment also results in a significantly increased final height, permitting a great number of the girls to attain a final height of more than 150 cm. However, early addition of estrogen decelerates the height velocity and reduces the gain in height.

Adolescent↗

Taking the clinic to the patient. Starting a satellite operation.

Triggered by a decreasing patient base and slow new patient growth, one medical group reached the decision to start a satellite clinic. This case report outlines the major areas of concern in starting a satellite operation, including choosing a location and office, staffing medical records, and projecting expenses and revenues. Though the results of this undertaking proved to be disappointing (the satellite is due to be closed), several critical success factors have emerged.

Group Practice↗

[ICH M4: the standardized international restration dossier or "C.T.D." (common technical document)].

The ICH E3 guideline "Structure and Content of Clinical Study Reports" has allowed to harmonize the structure and the contents of the study report, as well as the information to be provided in each section. Industry has wished to pursue this process and has asked for an ICH guideline regarding the complete harmonization of the registration dossier, called "C.T.D." or Common Technical Document, for the three parts of the dossier in terms of quality, safety and efficacy. A survey was carried out comparing the documentation to be provided, identifying the differences and potential obstacles to harmonization, and assessing the advantages and disadvantages of the C.T.D. The C.T.D. leading to a single registration dossier should allow pharmaceutical companies and health authorities to make savings in terms of resources (time, money and expertise), to facilitate exchanges through IT systems and to improve communication. The ICH expert groups in charge of the pharmaceutical, pre-clinical and clinical parts of the dossier are expected to start their work in February 1998. By February 2000, it is anticipated that this project will become a valuable tool for the international registration and evaluation of medicines. The C.T.D. should improve the dialogue between industry and authorities with regard to medicines and public health.

Drug Industry↗

[Psychophysiological condition of wounded].

Psychological and psychophysiological investigation of the casualties with injured extremities was conducted in 3-5 and in 30-40 days after being wounded. It has shown that during stay in clinic some dynamics in their psychic state was observed. Marked asthenization was the leading sign in the initial treatment period. That's why it is reasonable to use not exhausting projective methods and some short questionnaires (scales) at this stage. In a month after starting treating the casualties the aggressive tendency, mood decrease, increase in the reactive anxiety level, sympathetic tonus of vegetative nervous system were coming into the foreground. It characterizes the development of posttraumatic stress disorders. Gradual increase in the casualties' activity is also typical of the hospital treatment period. That's why the psychological and psychophysiological investigation can be supplemented with volumetric personal tests.

Adaptation, Psychological↗

[The question of health regenerationism and its debate during the second republic: elements of class and ideology].

This study analyzes the consensus and conflicts with regard to the criteria for what constituted the health problem in Spain and its possible solutions. We start from the assumption that the general idea of change, implicit in the regenerationist project of the end of the nineteenth century, constituted one of the active elements in the proclamation of the Second Republic. We consider three aspects: the critque of a situation in which living conditions had a negative influence on issues of health and disease; the role of technicians or experts--in this case physicians--; and the role of educational aspects. As sources we used the labor press, the general press associated with certain ideological options and social groups, and the Diario de Sesiones de las Cortes. We found that different strategies and concrete choices in health issues, and hence diverse practical interests reflecting differences in class, political affiliation and ideology, could be manifested under apparently identical expressions, eg, those related with the action of regeneration.

Government↗

Drug firms pledge with WHO to combat AIDS.

In a joint statement, WHO (the World Health Organization) and IFPMA (the International Federation of Pharmaceutical Manufacturers) committed themselves to use their expertise "towards the resolution of the HIV/AIDS pandemic and to explore all possible areas for cooperation". Work towards discovering and developing new drugs and vaccines would proceed as rapidly as possible. In the statement, each institution defined its roles in the research, development and marketing and distribution of HIV/AIDS drugs and vaccines, with special attention to the respect of ethical standards in clinical trials, and to the accessibility of any drugs and vaccines which become available. One of WHO's main objectives is to promote the development of safe and effective new HIV/AIDS products which will be made available at prices that take into account the limited financial means of the public sector to purchase medical supplies for use in developing countries. By the year 2000, according to WHO projections, up to 40 million people may have been infected with HIV since the start of the pandemic. At the end of 1993 the cumulative number of infections was 15 million. Most new infections will occur, as they have in the past, in countries least able to afford adequate prevention measures or suitable treatment. The joint statement reflects the deep concern of IFPMA and WHO for the devastating impact HIV/AIDS can have in such countries--not only on the health of their populations, but also socially or economically.

Acquired Immunodeficiency Syndrome↗

Paperless medical records: reinventing the patient experience.

At North Shore Magnetic Imaging Center, the patient paper medical record system was becoming very cumbersome, and it served as a source of frustration for everyone involved: patients, technologists, radiologists, and staff members. The center's mapping of a typical patient experience indicated that, from the initial phone call scheduling an exam to a completed visit (claim processed and payment received), a record could be handled by as many as 20 sets of hands! In June 2002, the center's growth and a concern that patients were losing a one-on-one experience with the medical staff led to an evaluation of workflow processes existing at that time. The evaluation began with a survey of staff members, center management, radiologists, and referring physicians. Their responses indicated 3 common themes: stress, overload, and frustration over systems in place. Comments from the survey were grouped into 3 areas: Continue to Do, Stop Doing, and Start Doing. The Start Doing responses provided solid objectives. The center set out to establish a breakthrough project that included all stakeholders--patients, staff, management, and radiologists. The Reinvention Project had 2 primary goals: move to a paperless environment and increase the level of patient care. The project was divided into internal and external teams. The internal team, called the Reinvention Team, was responsible for the actual hands-on aspects of the process. There were numerous external teams; each had defined roles and specific outcomes for achievement. The external teams' responsibilities included implementing an Internet protocol telephone system; researching voice recognition; restructuring job descriptions, training manuals, and performance evaluations; and conducting a patient-centered focus group.

Hospital Shared Services↗

Telebaby videostreaming of newborns over Internet.

New information technologies are used to fill gaps in our need for communication. Hospitals are now starting to discover the possibilities of multimedia communication for their patients. Telebaby is a project of the University Medical Centre Utrecht that allows parents to view their newborn on the intensive care, high care or medium care unit at home. Standard Internet technology for distributing multimedia allows parents to virtually "visit" their baby more often and give parents the feeling of control. A non-complex technical system like Telebaby is easily adopted by the parents, implementing it in a closed environment like a hospital is the real challenge.

Academic Medical Centers↗