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[Quality of life and well-being in a housing project in Berlin--experiences gained in cooperation between a community health promotion office and a university-based public health project].

The realization of a community-based health promotion within the framework of a cooperation between a public health office and a university-based PH project is described and discussed. First of all, the project, the cooperating partners and the common aims are described. We will then deal with telephone survey as the method used, and present the results. In a third step the methods and results of the "future workshops" are discussed. Finally there is a critical reflection on the course of the project, the limiting factors of the actions and consideration of further developments. The project dealt with was a cooperation of a community public health agency (Plan- und Leitstelle) in the district of Berlin-Wilmersdorf and the research project A8 "Cooperative project development for communal health promotion" of the Berlin Centre for Public Health at the Technical University Berlin. Starting point was the agreement for those politically responsible of the district that the living quarter "Schlangenbader Strasse" was a focus of social problems. The quarter had been built in 1980 above a highway with 1800 apartments for 4000 people. Health promotion was defined as a concern of a wide range of sectors within the community. Mutual rights and responsibilities of the cooperating partners were laid down in a contract. The Plan- und Leitstelle tried to gain experience with the definition of health promotion the university partners stood for. This introduces a notion of health beyond bio-medical understanding and deals with the connection of quality of life, well-being and the environment in the residential area. Thus health- or sickness-related variables were not specifically asked for. One result is that actors within the given framework are reluctant to permit operationalisation of this concept. The telephone survey reached 324 household within 10 working days. 68p.c. of the interviewed were pleased with the comfort of the apartments, 37p.c. enjoyed the peace and quiet and 35p.c. the green around the housing project. Unpleasant were for 51p.c. the dirt, 33p.c. complained about vandalism, 30p.c. about the high rent, especially the extras. Safety improvements were asked for by 17p.c. Some 12p.c. were willing to become involved in bringing about those improvements. This willingness was confirmed by the good response to two future workshops with those living in the quarter.

Advertising↗

Postnatal development of the inferior olivary complex in the rat. II. Topographic organization of the immature olivocerebellar projection.

The state of organization of the olivocerebellar projection in newborn and 5-day-old rats has been analyzed by autoradiography of anterogradely transported 3H-leucine, as well as by retrograde transport of horseradish peroxidase. The efferent axons of the inferior olivary neurons are already present and already highly organized in the cerebellum of newborn rats. Most of the autoradiographic labelling subsequent to the injection of 3H-leucine into the inferior olive is seen in the subcortical medullary zone. Labelled axons only partially invade the gray matter, where they reach the zone occupied by randomly distributed Purkinje cells. At this immature stage, olivocerebellar projections are already entirely crossed and distributed according to a pattern which is similar to the adult. At the fifth postnatal day olivocerebellar projections have moved from the medullary zone toward the interface between the molecular and the granular layers where Purkinje cells have arranged in a monolayer. Evidence for translocation of climbing fibers from their perisomatic to their peridendritic position is already distinct in these young cerebella. Combination of anterograde and retrograde fiber system tracing experiments discloses the following crossed topography of olivocerebellar projections: The caudal half of the medial accessory olive projects mainly to the vermis of the posterior lobe, whereas its rostral half projects to the flocculus, paraflocculus, and the intermediate cortex. The principal olive, ventral and dorsal lamellae, supplies climbing fiber inputs to the hemispheric cortex. The caudal half of the dorsal accessory olive projects to the lateral portion of the vermis of the anterior lobe, whereas neurons in its rostral half send their axons toward the intermediate cortex. This topographic arrangement is, therefore, similar to that reported for adult mammals. The present results, alone or when compared with those obtained during other studies on the synaptogenesis between climbing fibers and Purkinje cells, allow the following conclusions: The climbing fibers enter the cerebellar cortex before Purkinje cells have reached the developmental phase compatible with synaptogenesis. They wait in the medullary white matter until appropriate maturation of their cellular targets. Olivocerebellar topography is roughly similar in newborn, 5-day -old, and adult rats. Synaptogenesis between climbing fibers and Purkinje cells, which is known not to start before the second postnatal day, is not necessary for the establishment of the topographic organization of the olivocerebellar projection.

Animals↗

Structure and function of the human genome.

The human genome project has had an impact on both biological research and its political organization; this review focuses primarily on the scientific novelty that has emerged from the project but also touches on its political dimensions. The project has generated both anticipated and novel information; in the later category are the description of the unusual distribution of genes, the prevalence of non-protein-coding genes, and the extraordinary evolutionary conservation of some regions of the genome. The applications of the sequence data are just starting to be felt in basic, rather than therapeutic, biomedical research and in the vibrant human origins and variation debates. The political impact of the project is in the unprecedented extent to which directed funding programs have emerged as drivers of basic research and the organization of the multidisciplinary groups that are needed to utilize the human DNA sequence.

Base Sequence↗

Older driver involvements in police reported crashes and fatal crashes: trends and projections.

OBJECTIVES: Older drivers have become a larger part of the driving population and will continue to do so as the baby boomers reach retirement age. The purpose of this study was to identify the potential effects of this population increase on highway safety. METHODS: Driver involvement rates for all police reported crashes were calculated per capita, per licensed driver, and per vehicle-mile of travel for 1990 and 1995. Also, driver involvement rates for fatal crashes were calculated for 1983, 1990, and 1995. Based on current crash rates per licensed driver and estimates of the future number of licensed drivers, projections of crashes involving drivers aged 65 and older were made for years 2010, 2020, and 2030. RESULTS: Driver crash involvement rates per capita decreased with age, but fatal involvement rates per capita increased starting at age 70. The same pattern existed for involvement rates per licensed driver. For both all crashes and fatal crashes, involvement rates per mile driven increased appreciably at age 70. Using projections of population growth, it was estimated that for all ages there will be a 34% increase in the number of drivers involved in police reported crashes and a 39% increase in the number involved in fatal crashes between 1999 and 2030. In contrast, among older drivers, police reported crash involvements are expected to increase by 178% and fatal involvements may increase by 155% by 2030. Drivers aged 65 and older will account for more than half of the total increase in fatal crashes and about 40% of the expected increase in all crash involvements; they are expected to account for as much as 25% of total driver fatalities in 2030, compared with 14% presently. CONCLUSIONS: By most measures, older drivers are at less risk of being involved in police reported crashes but at higher risk of being in fatal crashes. Although any projections of future crash counts have inherent uncertainty, there is strong evidence that older drivers will make up a substantially larger proportion of drivers involved in fatal crashes by 2030 because of future increases in the proportion of the population aged 65 and older, and trends toward increased licensure rates and higher annual mileage among older persons. Countermeasures to reduce the anticipated death toll among older drivers should address the increased susceptibility to injury of older vehicle occupants in crashes.

Accidents, Traffic↗

Native topology or specific interactions: what is more important for protein folding?

Fifty-five molecular dynamics runs of two three-stranded antiparallel beta-sheet peptides were performed to investigate the relative importance of amino acid sequence and native topology. The two peptides consist of 20 residues each and have a sequence identity of 15 %. One peptide has Gly-Ser (GS) at both turns, while the other has d-Pro-Gly ((D)PG). The simulations successfully reproduce the NMR solution conformations, irrespective of the starting structure. The large number of folding events sampled along the trajectories at 360 K (total simulation time of about 5 micros) yield a projection of the free-energy landscape onto two significant progress variables. The two peptides have compact denatured states, similar free-energy surfaces, and folding pathways that involve the formation of a beta-hairpin followed by consolidation of the unstructured strand. For the GS peptide, there are 33 folding events that start by the formation of the 2-3 beta-hairpin and 17 with first the 1-2 beta-hairpin. For the (D)PG peptide, the statistical predominance is opposite, 16 and 47 folding events start from the 2-3 beta-hairpin and the 1-2 beta-hairpin, respectively. These simulation results indicate that the overall shape of the free-energy surface is defined primarily by the native-state topology, in agreement with an ever-increasing amount of experimental and theoretical evidence, while the amino acid sequence determines the statistically predominant order of the events.

Computer Simulation↗

Finding the needle in the haystack: why high-throughput screening is good for your health.

High-throughput screening is an essential component of the toolbox of modern technologies that improve speed and efficiency in contemporary cancer drug development. This is particularly important as we seek to exploit, for maximum therapeutic benefit, the large number of new molecular targets emerging from the Human Genome Project and cancer genomics. Screening of diverse collections of low molecular weight compounds plays a key role in providing chemical starting points for iterative optimisation by medicinal chemistry. Examples of successful drug discovery programmes based on high-throughput screening are described, and these offer potential in the treatment of breast cancer and other malignancies.

Antineoplastic Agents↗

Addressing health disparities through dental-medical collaborations, Part III: Leadership for the public good.

This is the third in a series of articles featuring dental-medical collaborations to reduce oral health disparities. Previous articles have targeted disparities among children, the elderly, and those with mental retardation and developmental disabilities and the importance of cultural factors in health disparities. Articles in this third group describe projects that originated in the public health sector or utilize public health approaches. They include training of non-dental providers and Head Start/Early Head Start workers in children's oral health promotion; case management to ensure early preventive medical, dental, and developmental services for children; and a dental school-led outreach, training, and research effort to address oral cancer disparities. In this introductory article, we review lessons learned from the entire series of projects reported in these articles. The primary take-home message is that educational changes are needed in dental and medical training to better address oral health disparities. Other important lessons include the value of local or state-specific data, the need for partnerships with key stakeholders, and the role of financial incentives in leveraging change. We recommend more attention to outcome assessments in educational initiatives, greater partnering with families and patients, and utilization of change-management methodologies with systems, providers, and patients. We also advocate increased collaboration with the public health sector and bold leadership in dental education.

Adolescent↗

Densitometric studies on the shadows of paranasal sinuses in sagittal projection.

In taking a X-ray photography of the head in sagittal projection, it is most important that the center of the X-ray beam passes exactly through the median-sagittal line. If the subject turns his head either to the right or to the left, the paranasal sinuses become denser on one side, leading to erroneous interpretation of the radiographic findings. In order to eliminate such a misinterpretations, studies were carried out on the following: 1) Application of a standard of what degree of head turning to either side would start to influence judgment of the shadow of the paranasal sinuses. 2. Application of a standard to judge whether they are projected to an exact center position or not in actually diagnosing the X-ray films.

Absorptiometry, Photon↗

Beyond a western bioethics?

Like theology and ethics generally, bioethics has increasingly developed a global consciousness. Controversies over AIDS research and access to affordable AIDS treatment have generated new awareness about the importance of international collaboration as well as the difficulty of achieving moral consensus across economic, political, and cultural divides. Advances in scientific and medical knowledge through initiatives such as the Human Genome Project invite new questions about the nature of health care as a common good. This budding global consciousness serves as a starting point for examining contemporary challenges to the secular, principle-based Western bioethics that has dominated national and international debate for three decades.

Acquired Immunodeficiency Syndrome↗

Allocating capital systemwide. Who gets how much and why.

The maturing of multi-institutional healthcare systems has created a need for systemwide approaches to managing investment in capital expenditures. Historically, hospitals have allocated capital using traditional capital budgeting techniques, including discounted cash flow, net present value, and internal rate of return methodologies. Now systems can use a multifactored model to allocate capital among member hospitals. This approach uses historical and projected financial and statistical information to quantify the risks member hospitals face. At the system level, capital allocation decisions should start with the strategic and financial planning processes. Catholic systems face an additional caveat: The system's mission statement drives the planning processes. Conceptually, the capital allocation plan is an attempt to value each hospital as a going, or viable, concern. From this perspective, value is understood as a function of expected return, the certainty of the return, and the return offered by similar investments in other hospital markets. Despite the many determinants of business and financial risk, much of the variance in asset market value can be explained through five assessment criteria: market demographics, position within the market, historical and projected financial performance, historical utilization, and third-party reimbursement mix.

Capital Expenditures↗

The shaping of personality: genes, environments, and chance encounters.

I started my career as a clinical psychologist with an interest in personality assessment. But a loss of faith in psychoanalytic theory, projective tests, and clinical case studies in general led to a shift in my interests to personality research. Subsequent jobs at research institutes and universities allowed me to indulge in science. I developed the trait-state concept and its application in tests for affect measurement. For 10 years I did experimental research in the field of sensory deprivation. The sensation seeking idea and tests evolved from this work but soon expanded to many other areas. Research in the biological basis of sensation seeking started with genetic and psychophysiological research, but research conducted in other laboratories also pointed to a psychopharmacological basis for the trait. Over the last several decades, I have formulated a psychobiological model for personality. I have used factor analysis and the biosocial model to develop an "alternative-five" factorial trait structure for personality.

Environment↗

Aerosol lidar intercomparison in the framework of the EARLINET project. 3. Raman lidar algorithm for aerosol extinction, backscatter, and lidar ratio.

An intercomparison of the algorithms used to retrieve aerosol extinction and backscatter starting from Raman lidar signals has been performed by 11 groups of lidar scientists involved in the European Aerosol Research Lidar Network (EARLINET). This intercomparison is part of an extended quality assurance program performed on aerosol lidars in the EARLINET. Lidar instruments and aerosol backscatter algorithms were tested separately. The Raman lidar algorithms were tested by use of synthetic lidar data, simulated at 355, 532, 386, and 607 nm, with realistic experimental and atmospheric conditions taken into account. The intercomparison demonstrates that the data-handling procedures used by all the lidar groups provide satisfactory results. Extinction profiles show mean deviations from the correct solution within 10% in the planetary boundary layer (PBL), and backscatter profiles, retrieved by use of algorithms based on the combined Raman elastic-backscatter lidar technique, show mean deviations from solutions within 20% up to 2 km. The intercomparison was also carried out for the lidar ratio and produced profiles that show a mean deviation from the solution within 20% in the PBL. The mean value of this parameter was also calculated within a lofted aerosol layer at higher altitudes that is representative of typical layers related to special events such as Saharan dust outbreaks, forest fires, and volcanic eruptions. Here deviations were within 15%.

Journal Article↗

[Magnetic resonance angiography--the start of the end of conventional angiography?].

Magnetic resonance angiography (MRA) is a new, non-invasive technique using magnetic resonance imaging to create projection images of vessels. The article gives a simplified explanation of the basic principles involved, and presents the preliminary experiences at Rikshospitalet, the National Hospital of Norway, using magnetic resonance angiography in the study of carotid and renal arteries. It is concluded that this method holds promise for more extensive use in the future. The method is likely to replace at least some of the routine conventional angiography performed today.

Angiography↗

Changes in the segmental pattern of sensory neuron projections in the chick hindlimb under conditions of altered cell adhesion molecule function.

In the developing chick hindlimb, pathfinding by sensory axons is affected by their interactions with other axons entering the limb. Cell adhesion molecules (CAMs) expressed on the growing axons are likely to influence these interactions. Accordingly, to elucidate how CAMs affect sensory axon pathfinding, we injected antibodies that block the functions of NCAM, G4/L1, or N-cadherin into the hindlimb, starting at St. 25, when all motoneuron axons but only a few sensory axons had entered the plexus. In each case, the segmental pattern of projections was assessed 2-3 days later by retrogradely labeling individual peripheral nerves. With all perturbations, the gross anatomical nerve pattern developed normally; that is, some sensory axons formed cutaneous nerves while other sensory axons projected to muscles. However, the segmental pattern of sensory projections was changed when either G4/L1 or N-cadherin function was blocked in that fewer sensory axons crossed the anterior-posterior axis of the plexus. A likely reason for this effect is that anti-G4/L1 and anti-N-cadherin each decreased the amount of fasciculation and that sensory axons are less able to travel across the plexus when they are defasciculated. Anti-G4/L1 affected both cutaneous and muscle sensory projections while anti-N-cadherin affected cutaneous but not muscle sensory projections, in accord with known differences in the expression of these two CAMs on sensory and motoneuron axons. Although anti-NCAM did not appear to alter sensory projections, when polysialic acid (PSA) was enzymatically removed from NCAM, there was a marked increase in cutaneous projections from the most proximate DRG, although muscle sensory projections were unchanged. PSA removal may cause an increase in fasciculation that forces sensory axons to track along neighboring axons. Thus, without PSA, cutaneous axons project more in accord with the relative anterior-posterior positions they had as they entered the plexus. Taken together, these studies suggest that axonal fasciculation mediated by CAMs and regulated by PSA influences the ability of sensory growth cones to navigate through the plexus and project along the correct peripheral nerves.

Afferent Pathways↗

Effect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project.

BACKGROUND: The Stockholm I and II randomised trials demonstrated the value of preoperative radiotherapy in preventing local recurrence in rectal cancer. This, study investigated the potential for further improvement by introduction of the concept of total mesorectal excision (TME) to surgeons in Stockholm, Sweden. METHODS: Workshops started in 1994 and included 11 television-based demonstrations and two histopathology sessions. The study population consisted of all patients who underwent abdominal operations for rectal cancer in Stockholm County during 1995-96 (TME project; n=447). Outcomes at 2 years were compared with those from the Stockholm I (n=790) and II (n=542) trials as historical controls. FINDINGS: For patients with curative abdominal resections, there were no differences between the Stockholm I (n=686), Stockholm II (n=481), and TME project (n=381) groups in 30-day mortality (30 [4%], six [1%], and 12 [3%]), anastomotic leakage (27 [10%], 18 [9%], and 23 [9%]), or all complications (204 [30%], 169 [35%], and 134 [35%]). This similarity was achieved despite a decrease in the proportion of abdominoperineal procedures from 55-60% to 27%. Local recurrence occurred in significantly fewer of the TME group than of the Stockholm I and II groups (21 [6%] vs 103 [15%] and 66 [14%], p<0.001) as did cancer-related death (35 [9%] vs 104 [15%] and 77 [16%], p<0.002). INTERPRETATION: A surgical teaching initiative had a major effect on cancer outcomes. The proportion of abdominoperineal procedures and the local recurrence rate decreased by more than 50% and there is already evidence of a decline in rectal-cancer mortality.

Adult↗