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The knowledge, attitudes and practices of rural women in southern Nigeria are at least as important as the availability of modern obstetric care in the fight against haemorrhage in pregnancy. Community-based interventions taking this into account are necessary if the considerable mortality associated with the condition is to be significantly reduced.
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We have been pleased with our initial experience in an evolving program. As newer surgical and radiotherapy techniques have become available, the role of radiosurgery has been and will continue to be modified. As more commercially available systems have been marketed, the availability will become more widespread. A battery of residents in neurosurgery and radiation oncology trained in these technologies will provide leadership and future directions of this therapy.
No previous studies have examined the influences of cultural background on the provision of contraceptive services to females under 16 years of age. A research project was undertaken to investigate any differences between general practitioners trained in the United Kingdom and those trained in the Indian sub-continent in relation to contraceptive service provision to females under 16 years of age. A self-completion postal questionnaire survey was distributed to 230 unrestricted principal general practitioners across Scotland. Subjects were identified from the Medical Register. Half of the sample consisted of all those working in Scotland who had been trained in the Indian sub-continent. The other half were a comparable group that had been trained in the United Kingdom and were selected by quasi-random quota sampling. The response rate was 57 per cent (131/230). General practitioners in the study who had trained in the Indian sub-continent were found to be significantly less likely to provide contraceptive services to a female under 16 years of age than those who had trained in the United Kingdom. Cultural background may be influential in general practitioner provision of contraceptive services to females below the legal age of consent for sexual intercourse. In order to obtain more conclusive evidence a larger study is necessary. Such investigations must be undertaken with appropriate sensitivity and social awareness.
Evaluation of disease outcome is central to the assessment of tuberculosis (TB) control programmes. In the study reported in this article we examined the factors influencing the measurement of outcome, survival rates during and after treatment, smear conversion rates, and relapse rates for patients diagnosed with TB in a rural area of Malawi between 1986 and mid-1994. Patients with less certain diagnoses of TB were more likely to die than those with confirmed TB, both among those who were seropositive and those who were seronegative to human immunodeficiency virus (HIV). The mortality rate among smear-positive patients with a separate culture-positive specimen was half that of patients with no such diagnostic confirmation. Patients not registered by the Ministry of Health had much higher mortality and default rates than did registered patients. Among smear-positive patients, HIV serostatus was the most important influence on mortality both during and after treatment (crude hazard ratios (95% confidence intervals) = 5.6 (3.0-10) and 7.7 (3.4-17), resp.), but HIV serostatus did not influence smear conversion rates. The initial degree of smear positivity influenced smear conversion rates, but not mortality rates. No significant predictors of relapse were identified. Unless considerable care is taken to include all TB patients, and to exclude nontuberculous patients, recorded TB outcome statistics are difficult to interpret and may be misleading. In populations with high rates of HIV infection, TB target cure rates of 85% are unrealistic. When new interventions are assessed it cannot be assumed that factors which influence the smear conversion rate will also influence the mortality rate.
A course has been established in Switzerland which helps women refugees to defend the health of themselves and their families. A major effort is made to meet their linguistic needs and to achieve cultural acceptability.
The structure and desorption dynamics of mono- and multilayer samples of adenine, cytosine, guanine, and thymine on polycrystalline gold thin films are studied using temperature-programmed desorption-infrared reflection absorption spectroscopy (TPD-IRAS) and temperature-programmed desorption-mass spectroscopy (TPD-MS). It is shown that the pyrimidines, adenine and guanine, adsorb to gold in a complex manner and that both adhesive (adenine) and cohesive (guanine) interactions contribute the apparent binding energies to the substrate surface. Adenine displays at least two adsorption sites, including a high-energy site (210 degrees C, approximately 136 kJ/mol), wherein the molecule coordinates to the gold substrate via the NH2 group in an sp3-like, strongly perturbed, nonplanar configuration. The purines, cytosine and thymine, display a less complicated adsorption/desorption behavior. The desorption energy for cytosine (160 degrees C, approximately 122 kJ/mol) is similar to those obtained for adenine and guanine, but desorption occurs from a single site of dispersed, nonaggregated cytosine. Thymine desorbs also from a single site but at a significantly lower energy (100 degrees C, approximately 104 kJ/mol). Infrared data reveal that the monolayer architectures discussed herein are structurally very different from those observed for the bases in the bulk crystalline state. It is also evident that both pyrimidines and purines adsorb on gold with the plane of the molecule in a nonparallel orientation with respect to the substrate surface. The results of this work are discussed in the context of improving the understanding of the design of capturing oligonucleotides or DNA strands for bioanalytical applications, in particular, for gold nanoparticle-based assays.
We used dynamic electromyography and a motion analysis system to describe the muscle firing patterns in 10 shoulder muscles and the basic kinematics of a two-handed overhead medicine ball throw. Ten healthy male subjects with no history of shoulder injury were evaluated. The two-handed medicine ball throw was divided into three phases for analysis: cocking, acceleration, and deceleration. The average duration of the throw was 1.92 seconds; the cocking phase represented 56%, the acceleration phase 15.5%, and the deceleration phase 28.5% of the throw. In the cocking phase, the upper trapezius, pectoralis major, and anterior deltoid muscles showed high activity ( > 40% to 60% maximum manual test), and the rotator cuff muscles had moderate activity ( > 20% to 40%). In the acceleration phase, five of the muscles demonstrated high levels of activity ( > 40% to 60%) and the upper trapezius and lower subscapularis muscles had very high levels of activity ( > 60%). Analysis of the deceleration phase revealed high activity in the upper trapezius muscle and moderate activity in all other muscles except the pectoralis major. Our findings support the use of medicine ball training as a bridge between static resistive training and dynamic throwing in the rehabilitation of the overhead athlete. This training technique provides a protective method of strengthening that closely simulates portions of the throwing motion.
AIM: To determine 12-year dynamics of the average value of arterial blood pressure and arterial hypertension prevalence among adult residents of Ljubljana area in Slovenia, and to assess the probable contribution of World Health Organization's Countrywide Integrated Noncommunicable Diseases Intervention Program (CINDI) to observed dynamics. METHODS: A total of 4409 adults aged 25-64 participated in three successive cross-sectional surveys performed in Ljubljana area from late autumn to early spring 1990/1991, 1996/1997, and 2002/2003 (n(1990/91)=1692, n(1996/97)=1342, n(1990/91)=1375). Standardized measurements of systolic and diastolic blood pressure were performed. The subjects were considered to have hypertension if systolic/diastolic blood pressure was > or =140/90 mm Hg. The dynamics of average values of systolic and diastolic blood pressures and arterial hypertension was statistically assessed with multiple linear or logistic regression. RESULTS: After the adjustment for the effects of sex, age, and education, the average value of systolic blood pressure remained almost the same between 1990/1991 and 1996/1997 (130.6+/-20.3 and 130.6+/-19.6 mm Hg, respectively; P=0.728), whereas it significantly decreased to 127.6+/-17.8 mm Hg in 2002/2003 (P<0.001). The average value of diastolic blood pressure was not significantly different in 1990/1991, 1996/1997, and 2002/2003 (83.4+/-11.6 mm Hg, 84.1+/-11.4 mm Hg, and 83.5+/-11.2 mm Hg, respectively; P=0.059). The odds ratio for arterial hypertension increased significantly between 1990/1991 and 1996/1997 (P=0.001), but decreased between 1996/1997 and 2002/2003 (P=0.135). CONCLUSIONS: The values of blood pressure remained unchanged or increased during the first half of 12-year period, but decreased during the second half. The favorable decrease in average blood pressure could be attributed to systematic intervention promoted by CINDI program activities in Slovenia, which started in the late 1990s.
Given the quickly changing landscapes of both global HIV infection and the HIV prevention literature, it has become increasingly difficult to identify or design an effective HIV prevention program. The authors discuss methods of selecting an appropriate program so that readers can critically evaluate the literature and create a suitable program for their unique setting. The intent of this article is to provide the reader with analytic modeling tools and methodology to search effectively the literature so that an appropriate and successful HIV prevention program can by selected by an organization or project team.
We have developed a computer program for molecular dynamics (MD) simulation that implements the Split Integration Symplectic Method (SISM) and is designed to run on specialized parallel computers. The MD integration is performed by the SISM, which analytically treats high-frequency vibrational motion and thus enables the use of longer simulation time steps. The low-frequency motion is treated numerically on specially designed parallel computers, which decreases the computational time of each simulation time step. The combination of these approaches means that less time is required and fewer steps are needed and so enables fast MD simulations. We study the computational performance of MD simulation of molecular systems on specialized computers and provide a comparison to standard personal computers. The combination of the SISM with two specialized parallel computers is an effective way to increase the speed of MD simulations up to 16-fold over a single PC processor.
The National Diabetes Prevention and Control Program has a dynamic and evolving scientific foundation. This article describes this program and how seminal research studies provide an impetus for its public health policy and programs. The charge and challenges of integrating science into past, current, and future program designs are detailed, as are the program's accomplishments. Areas requiring new science are explored, including better research to translate new findings into clinical and public health practice and models to evaluate the effect of public health on improved outcomes. The epidemic of diabetes and its increasing burden on public health demands a better understanding of existing science and its limitations and informed public dialogue and policy responses.
Power, examined within a reinforcement exchange model, is proposed as an essential dynamism through which program evaluation is mounted, executed, and utilized. The ability of the program evaluator to influence or control the policies or operations of the evaluatee depends chiefly on an exchange of behaviors which nets all participants of the evaluation interaction a fair and sufficient "payoff" in terms of contingent reinforcements. Other contextual features of program evaluation, particularly those that constrain on utilization of the recommendations, are briefly discussed.
OBJECTIVE: Computerized software holds the potential for the novel assessment of the pain experience of patients with chronic pain not available through traditional paper-and-pencil methods. The aim of this study was to test the feasibility and discriminant validity of a dynamic computer-administered program for the assessment of pain. DESIGN: Three computer-administered programs were created to assess the intensity (dynamic visual analog scale DVAS]), character (dynamic verbal ratings), and location (dynamic pain drawings) of pain. The programs were administered to 115 chronic pain patients recruited from a hospital-based pain management program and 115 age- and gender-matched healthy individuals without pain. The healthy controls were instructed to respond as if they had chronic pain. RESULTS: Analyses showed pain patient DVAS pain intensity ratings to be significantly higher than ratings by the healthy group. Patients selected more words in describing their pain, rated those words higher, and marked significantly more pain locations than the comparison group. However, no differences were found in the DVAS ratings of emotional impact between patients and healthy individuals. CONCLUSIONS: Chronic pain patients were shown to differ from healthy individuals in their assessments of degree of pain intensity and pain location with the use of a novel computerized pain assessment program. Although further investigations are needed, these initial findings support the use of computer methods for the effective assessment of pain.
Methods to correct the QT interval for heart rate are often in disagreement and may be further confounded by changes in autonomic state. This can be problematic when trying to distinguish the changes in QT interval by either drug-induced delayed repolarization or from autonomic-mediated physiological responses. Assessment of the canine dynamic QT-RR interval relationship was visualized by novel programming of the dynamic beat-to-beat confluence of data or "clouds". To represent the nonuniformity of the clouds, a bootstrap sampling method that computes the mathematical center of the uncorrected beat-to-beat QT value (QTbtb) with upper 95% confidence bounds was adopted and compared with corrected QT (QTc) using standard correction factors. Nitroprusside-induced reflex tachycardia reduced QTbtb by 43 ms, whereas an increase of 55 and 16 ms was obtained using the Bazett (QTcB) and Fridericia (QTcF) formulae, respectively. Phenylephrine-induced reflex bradycardia increased QTbtb by 3 ms but decreased QTcB by 20 ms and QTcF by 12 ms. Delayed repolarization with E-4031 (1-[2-(6-methyl-2-pyridyl)ethyl]-4-methylsulfonylaminobenzoyl)-piperidine), an inhibitor of rectifier potassium current, increased QTbtb by 26 ms but QT prolongation calculations using QTcF and QTcB were between 12 and 52% less, respectively, when small decreases in heart rate (5-8 beats per minute) were apparent. Dynamic assessment of beat-to-beat data, using the bootstrap method, allows quantification of QT interval changes under varying conditions of heart rate, autonomic tone, and direct repolarization that may not be distinguishable with use of standard correction factors.
The review by Arndt Benecke focuses on chromatin, a major hallmark of eukaryotic life. The dynamic of chromatin and its underlying mechanisms are discussed. In addition, theoretical properties of chromatin associated with transcriptional regulation are presented. In the present brief comment on the review by Arndt Benecke, we wish to provide additional information regarding chromatin structure and in particular on the so-called "histone code hypothesis". We will discuss about the emerging idea that chromatin structure is much more complex than previously thought. The possibility that chromatin modifications may play important roles in biology beside transcriptional regulation will also be put forward.
Dynamic wedges have been used in clinical practice for many years. Obvious superiority of dynamic over physical wedges is accompanied by the increased overhead involved in verifying the accuracy and reliability of their use. Contrary to very limited QA required to ensure proper functioning of the physical wedges, dynamic wedges, like any other dynamic treatment, require a robust QA program. This work expands upon previous suggestions and describes a comprehensive QA program for Varian enhanced dynamic wedges (EDWs) and presents the results of an 18-month evaluation of these wedges. The QA program includes daily, monthly, and yearly tests and individual treatment QA at the onset of use of the EDWs. The results of the 18-month evaluation show reproducibility in the wedge factors of better than 1% and in dose profiles of better than 2% on a monthly basis. Daily output measurements are generally within 2% of expected values.