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PubMed1993

Goals of palliative cancer therapy: scope of the problem.

This article describes some of the problems of palliative cancer therapy and proposes possible solutions. The topics discussed include the reasons for death in cancer patients, the definition of intermediate and indirect as opposed to direct and measurable goals of treatment, the insufficient outcomes of palliative therapies and the problems associated with the separation of palliative treatment and palliative care. As a solution to these problems, a concept of Tumor versus Host Disease (TvHD) is discussed, and different end points for palliation are defined for daily oncology practice and oncology research. Finally, a way to collect data outside randomized trials is proposed, and the need for data collection is emphasized.

Goals↗
PubMed1994

Reciprocal activation and coactivation in antagonistic muscles during rapid goal-directed movements.

Seven normal subjects performed elbow extensions as rapidly as possible from an initial position to a visually defined target at 36 degrees in amplitude. In electromyograms, the reciprocal activation of the agonist and then antagonist bursts was always followed by simultaneous activation of the antagonistic muscles, i.e., coactivation. Instructions added to perform extensions "as rapidly as possible" changed coactivation; the command to "strongly fix the upper arm at the target" increased coactivation, whereas "relax immediately after the start of movement" made coactivation almost disappear. However, basic features of reciprocal activation remained the same. Other instructions given also changed coactivation on initiation and termination, while reciprocal activation was relatively unaltered. When subjects were encouraged to "relax immediately after the start of movement, but fix the upper arm quickly after attaining the target," coactivation initiated shortly after reaching the target (< 200 ms). Following the instruction to "relax the upper arm quickly after attaining the target," coactivation terminated rapidly after reaching the target (< 280 ms). The results show that instructions serve to change amplitude and timing of coactivation while keeping reciprocal activation relatively unaltered, suggesting that coactivation is controlled independently of reciprocal activation during rapid goal-directed movements.

Adolescent↗
PubMed2006

Extent to which accepted serum lipid goals are achieved in a contemporary general medical population with coronary heart disease risk equivalents.

This study examined lipid levels and the use of lipid-altering drugs in a contemporary general medical population without documented coronary heart disease (CHD) but with CHD risk equivalents. On the basis of present national guidelines, the following lipid values (in milligrams per deciliter) were considered optimal for this population: low-density lipoprotein cholesterol <100, high-density lipoprotein (HDL) cholesterol >or=40 in men and >or=50 in women, and non-HDL cholesterol <130 if triglycerides are >or=200. Of 44,052 active patients screened, 877 with CHD risk equivalents as defined by the Adult Treatment Panel III guidelines were identified. Most patients did not meet optimal lipid targets for low-density lipoprotein cholesterol (59%), HDL cholesterol (66%), and non-HDL cholesterol (72%). Indeed, 88% of patients did not meet >or=1 lipid goal. Statins were used in 57% of patients. In patients with low HDL cholesterol, only 4.7% were taking niacin and 4.9% fibrates. In the subgroup of patients with triglycerides >or=200 mg/dl, only 9.5% were taking fibrates and 8.2% niacin. In conclusion, the present analysis highlights the dramatic need to further improve preventive measures in a substantial proportion of high-risk patients with CHD risk equivalents.

Aged↗
PubMed2004

Parkinson's disease is associated with goal setting deficits during task switching.

Ten Parkinson's Disease (PD) patients and 10 control participants were tested using a task-switching paradigm in which there was a random task sequence, and the task was cued in every trial. Five PD patients showed a unique error profile. Their performance approximated guessing when accuracy was dependent on correct task identification, and was nearly perfect when accuracy did not depend on correct task identification or in conditions without task switching. Nonetheless, PD patients showed normal task-rule implementation, evidenced by their preparation-related reduction in the reaction-time task-switching cost. The results indicate that, without redundant task information, some PD patients have a specific goal setting deficit, reflected in a difficulty determining which task is currently relevant.

Adult↗
PubMed2004

Frontal cortex: goal-relatedness and the cortical motor system.

A recent study has shown that prolonged electrical stimulation of the ventral premotor cortex can evoke complex defensive movements. Moreover, neurons in this region show activity correlated with the vigour of an induced defensive reaction. These results support the idea that this cortical region encodes goal-related actions.

Animals↗
PubMed2004

Is the learning of goal-directed displacement effector-independent?

The present experiment was designed to investigate whether the learning of goal-directed locomotion is effector independent. To answer this question a bilateral transfer of learning paradigm was used. We wanted to find out whether learning can be transferred from a trained effector system to an untrained one. Sixteen participants were asked to proceed through virtual hallways, while walking on a treadmill or handling of a joystick, in order to cross a pair of oscillating doors. Participants received 1050 training trials on the specific effector system before being transferred to the untrained one. Results indicated a clear transfer from handling to walking and only a moderate transfer from walking to handling. This asymmetrical transfer provides partial support in favor of the effector independent hypothesis. Both the theoretical implications of this work and the possible mediating effect of calibration are discussed.

Adult↗
PubMed2006

Women's right to health and the Millennium Development Goals: promoting partnerships to improve access.

The Millennium Development Goals (MGD) represent a commitment of 189 member states that adopted them during the Millennium Summit in September 2000. This UN General Assembly recognized that gender equality and women's empowerment are both central to achieving sustainable development by means of combating poverty, hunger and disease. Neither reproductive nor sexual health was explicitly articulated in the original MDGs and indicators-a critical omission, as globally women are more disadvantaged than men. However, a clear link exists between all of the MDGs and the reproductive and sexual health of women, who cannot contribute to sustainable development, unless their right to health is met through improved access. The FIGO 2006 World Report on Women's Health addresses many issues critical to the success of the MDGs, with a focus on how partnerships have become a crucial vehicle to improve access to health for women.

Child Mortality↗
PubMed2005

Weight management goals and use of exercise for weight control among U.S. high school students, 1991-2001.

PURPOSE: The purpose of this study was to examine trends in weight management goals and the use of exercise for weight control among U.S. high school students. METHODS: As part of the Youth Risk Behavior Surveillance System, 6 national school-based surveys were conducted between 1991 and 2001. Each survey used a three-stage cross-sectional sample of students in grades 9-12. African-American and Hispanic students were oversampled. Logistic regression models were used to test for trends among gender and race/ethnic subgroups, controlling demographic changes over time. RESULTS: From 1991 to 2001, the percentage of female students trying to lose weight (61.7%-62.3%) or stay the same weight (15.4%-16.0%) did not change significantly. Among male students, trying to lose weight (22.7%-28.8%) and trying to stay the same weight (17.8%-21.5%) both increased significantly, while trying to gain weight decreased significantly (32.7%-26.3%). Among female and male students who were trying to lose weight or stay the same weight, the use of exercise for weight control increased significantly. Among students who reported using exercise for weight control, participation in vigorous physical activity > or = 3 days per week increased among African-American female students, and participation in strengthening exercises > or = 3 days per week increased among male students. CONCLUSIONS: These findings suggest increased interest in weight control among male adolescents, and increased use of exercise for weight control among female and male adolescents.

Adolescent↗
PubMed2006

Children's engagement and competence in personal recollection: effects of parents' reminiscing goals.

Parents' goal orientations in parent-child reminiscing were examined in this study, where 28 preschoolers (mean age = 46 months) experienced a standardized event. Dyads discussed the event that evening, with parents randomly assigned to either an "outcome-oriented" or a "process-oriented" condition. Outcome-oriented parents, who were told that children subsequently would be tested on event-related recall, were more controlling in these conversations compared with process-oriented parents, who were told that children's personal perspective would be assessed. Parents did not differ in their provision of structure. Children were interviewed 2 weeks later. Autonomy support in the parent-child conversation predicted children's engagement in the interview. Parental structure predicted children's recall of details and the coherence of their memories. Effects of parental reminiscing styles for children's memory and motivation to reminisce are discussed.

Aptitude↗
PubMed2004

The perceptual support of goal-directed displacement is context-dependent.

This study investigates the perceptual-motor organisation underlying the control of goal-directed displacement. We used a virtual reality set-up to study the locomotor interception of a moving ball. Subjects had to intercept moving balls by modifying displacement velocity if necessary, while the ball's place of arrival and the environment were manipulated. The results showed that subjects simultaneously managed multiple sources of information and placed priority on the most salient variables, depending on the task and environmental constraints.

Goals↗
PubMed1996

Conflicting goals of skid training.

Efforts to make novice drivers drive more safely on slippery roads by means of special courses have mainly failed. In order to understand why the courses have failed, the views of instructors and students on the goals of skid training courses were compared. The importance given to anticipating vs manoeuvring skills was analysed. After completing a skid training course, students in four Nordic countries (Denmark, Finland, Norway and Sweden) assessed manoeuvring skills to be equally important to anticipating skills in the courses. However, instructors assessed anticipating skills to be more important than manoeuvring skills. The differences between the assessments of instructors and students were the same in all four countries. Manoeuvring exercises are widely used in the courses although the main purpose of these courses is to develop anticipating skills. The exercises may give students the impression that manoeuvring skills are more important than anticipating skills. Manoeuvring exercises also increase their self-confidence and may lead to underestimation of the risks involved, resulting in e.g. driving at higher speed.

Accidents, Traffic↗
PubMed1999

Goal neglect and inhibitory limitations: dissociable causes of interference effects in conflict situations.

Interference effects on task performance in conflict situations might reflect real limitations in inhibitory capabilities or failures to fully or consistently utilize such capabilities in executive control of task performance. We propose that useful clues regarding the actual cause of interference effects may be obtained from examination of their robustness within and between experimental conditions. We illustrate this approach for two major types of interference effects that have commonly been attributed to fundamental inhibitory limitations: Stroop-type interference and residual switch costs. We present results that indicate that these effects may not be unavoidable consequences of fundamental inhibitory limitations but may stem from goal neglect, i.e., failures to fully or effectively deploy inhibitory capabilities. These results indicate that, in addition to mean performance levels, variability of task performance may provide a valuable source of evidence regarding the actual cause of performance limitations or deficits in conflict situations.

Conflict, Psychological↗
PubMed1978

Resident training goals in obstetrics and gynecology for the 1980's. Presidential address.

Residency training goals and manpower needs in the 1980's and beyond should bear a consistent relationship. Projections for supply and demand for obstetrics and gynecology and for those medical specialties with overlapping responsibilities, though fraught with uncertainties, suggest that currently approved training programs in obstetrics and gynecology will meet clinical manpower needs for 1990. The role of the obstetrician-gynecologist in the primary care of women will be increasingly shared with others and the trend in urban areas for task delegation seems likely to increase. The popular and pervasive emphasis on primary care carries with it the serious risk that the present shortage of qualified investigators may not be corrected in the next decade. This could seriously hamper our efforts to recruit new faculty and maintain quality in our training programs.

Goals↗
PubMed1986

What is "tight control" of diabetes? Goals, limitations, and evaluation of therapy.

Complete normalization of the blood glucose concentration is the ideal goal in patients with diabetes. Because of deficiencies in therapeutic modalities for diabetes, achievement of approximation of normoglycemia is usually a satisfactory result. Generally, blood glucose ranges of 70 to 120 mg/dl preprandially and less than 160 to 180 mg/dl 90 minutes postprandially in nonpregnant patients with diabetes are considered appropriate. Diurnal variations in glycemia can be caused by the size and composition of meals, the time of day a meal is eaten, stress, and exercise. Self-monitoring of blood glucose by the patient and measurement of glycosylated hemoglobin have been useful in achieving control of diabetes.

Blood Glucose↗
PubMedDate not supplied

Goal-directed instrumental action: contingency and incentive learning and their cortical substrates.

Instrumental behaviour is controlled by two systems: a stimulus-response habit mechanism and a goal-directed process that involves two forms of learning. The first is learning about the instrumental contingency between the response and reward, whereas the second consists of the acquisition of incentive value by the reward. Evidence for contingency learning comes from studies of reward devaluation and from demonstrations that instrumental performance is sensitive not only the probability of contiguous reward but also to the probability of unpaired rewards. The process of incentive learning is evident in the acquisition of control over performance by primary motivational states. Preliminary lesion studies of the rat suggest that the prelimbic area of prefrontal cortex plays a role in the contingency learning, whereas the incentive learning for food rewards involves the insular cortex.

Adaptation, Psychological↗
PubMed2002

Meeting international goals in child survival and HIV/AIDS.

BACKGROUND: After a decade of focused efforts to reduce under-5 mortality results have been mixed, with the HIV/AIDS epidemic often used to explain reversing trends. We investigated this assumption by estimating HIV-attributable under-5 mortality in 39 countries in sub-Saharan Africa and comparing it to total mortality in children younger than 5 years between 1990 and 1999. METHODS: Annual HIV-attributable under-5 mortality was estimated in a four-step process with previously obtained data from antenatal clinics in 39 countries based on HIV sero-prevalence among pregnant women. This process produced estimates of: the number of children born to HIV-infected women; the number of children infected via mother-to-child-transmission of HIV; the number of HIV-infected children who died before age 5 years; and the number of HIV-infected children who died before age 5 years adjusted for competing causes of mortality. FINDINGS: An estimated 330,000 children younger than age 5 years died in sub-Saharan Africa in 1999 with HIV infection. When corrected for competing causes of mortality, HIV infection caused 7.7% of under-5 deaths in 1999, a significant rise from 2% in 1990. Five countries (Botswana, Namibia, Swaziland, Zambia, and Zimbabwe) have rates of HIV-attributable under-5 mortality of above 30 per 1000. An additional 16 countries have HIV-specific under-5 mortality rates between 10 and 25 per 1000. The remaining 18 countries have rates under 10 per 1000. INTERPRETATION: HIV/AIDS is an increasingly important cause of under-5 mortality in Africa. However, in many African countries, slowing or reversal of trends in child mortality cannot be explained by HIV alone. To meet international goals for reductions in child mortality, efforts must continue to focus on HIV/AIDS, but must also strengthen health systems that can deliver available interventions for the other major killer diseases of children in the developing world.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Measures of goal attainment and performance in the World Health Report 2000: a brief, critical consumer guide.

The World Health Report 2000 presents a set of indicators and global indices by which different countries' goal attainment and performance in health care may be compared. The paper explains the methods employed in some detail and raises a number of critical points. The WHO has gone too far in compressing the results of potentially useful primary measurements in summary indices with unclear meaning, dubious validity and little practical relevance to decision makers facing specific tasks and problems. The WHO has also gone too far in applying the same measuring rods to countries with different histories and values and different stages of development, and in encouraging international comparisons that are of little use to policy makers. The WHO needs to add an indicator of equality in access to its present indicator of fairness in financing.

Delivery of Health Care↗
PubMed2003

Goal-directed abdominal ultrasonography: impact on real-time decision making in the emergency department.

The impact of "goal-directed" abdominal ultrasound (US) on real-time decision making in the emergency department (ED) was studied, with specific emphasis on the certainty of diagnosis, treatment, and disposition plans. A prospective, interventional study enrolled 212 patients at a county teaching hospital ED, who underwent bedside US by experienced ED sonographers. A study questionnaire was completed documenting the US indication, working diagnosis, treatment, and disposition plan. The physicians assigned pre-test and post-test levels of certainty for the diagnosis, treatment plan, and disposition on an integral scale from 1 to 10. Scores for diagnosis were further categorized into low (1-3), moderate (4-7) and high certainty of disease. Absolute mean changes in level of certainty for diagnosis, treatment, and disposition were 3.2 (95% CI 3.1-3.3), 2.0 (95% CI 1.9-2.1), and 1.9 (95% CI 1.8-2.0), respectively. The direction of change after US for certainty of diagnosis was evenly split, with 47% increasing and 47% decreasing. The majority of patients categorized as either high or low certainty of disease had US results concordant with the physician's initial assessment. However, 16% moved from either high to low or from low to high certainty categories after US. Patients with moderate certainty moved evenly to either the low or high post-test category in 97% of cases. Treatment and disposition decisions were less impacted by US, with the majority of cases increasing in certainty irrespective of the US results. Bedside ultrasonography in the ED has an important impact on real-time decision-making, particularly in terms of the certainty of diagnosis.

Abdominal Injuries↗