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PubMed2003

ESTprep: preprocessing cDNA sequence reads.

MOTIVATION: High accuracy of data always governs the large-scale gene discovery projects. The data should not only be trustworthy but should be correctly annotated for various features it contains. Sequence errors are inherent in single-pass sequences such as ESTs obtained from automated sequencing. These errors further complicate the automated identification of EST-related sequencing. A tool is required to prepare the data prior to advanced annotation processing and submission to public databases. RESULTS: This paper describes ESTprep, a program designed to preprocess expressed sequence tag (EST) sequences. It identifies the location of features present in ESTs and allows the sequence to pass only if it meets various quality criteria. Use of ESTprep has resulted in substantial improvement in accurate EST feature identification and fidelity of results submitted to GenBank. AVAILABILITY: The program is freely available for download from http://genome.uiowa.edu/pubsoft/software.html

Algorithms↗
PubMed1987

The Monterey County Health Initiative. A post-mortem analysis of a California Medicaid demonstration project.

Twenty months after the California State Department of Health Services turned its Medicaid program in Monterey County over to a local health care authority, the Monterey County Health Initiative (MCHI), the state terminated the pilot project in favor of a return to fee-for-service reimbursement. The MCHI, plagued from its inception with shaky provider support and a flawed program design, failed to demonstrate its anticipated cost savings. The key features of this failure were overly generous fees for primary case managers, inadequate utilization control measures, a general hesitancy to assume the necessary gatekeeper function, and a management information system that was not fully operational until well into the implementation of the program. Policy implications and recommendations for future state-sponsored Medicaid demonstration projects are discussed.

California↗
PubMedDate not supplied

A multicultural and multilingual outreach program for cervical and breast cancer screening.

Partners in Health: The Breast and Cervical Health Cooperative is a New Orleans-based community health intervention program designed to increase the access of underserved multicultural, multiethnic, and multilingual women to cervical and breast cancer health education and screening. This article describes innovative approaches used over the past 4 years to successfully link the services of a university cancer center to women in the community through a culturally sensitive outreach program. In addition to cancer screening, health referrals were made for many other diverse medical/social complications such as hypertension, obesity, and violence. The program initially targeted African American women but during the past year has successfully integrated Latinas. Key to the program's success was the collaboration of community lay health educators, community churches, advanced practice nurses, and public health programs. This article provides an overview of program strategies and outcomes and discusses multicultural and multilingual issues.

Black or African American↗
PubMed2000

Sex differences in cardiac rehabilitation.

OBJECTIVE: To determine and compare the baseline characteristics and outcomes between men and women in a Canadian cardiac rehabilitation program. DESIGN: Nonrandomized, retrospective, observational study with a before and after research design. SETTING: The Prevention and Rehabilitation Centre at the University of Ottawa Heart Institute, Ottawa, Ontario, a tertiary cardiac care centre. PATIENTS: Three hundred and eighty-seven patients, 82% male aged 59+/-10 years and 18% female aged 61+/-4 years, who were enrolled in the on-site cardiac rehabilitation program between November 1, 1995 and April 1, 1997. INTERVENTION: A three-month, multifactorial cardiac rehabilitation program that incorporates exercise training, risk factor modification, education and psychosocial support. MAIN RESULTS: Fewer than 20% of all rehabilitation participants (n=70; 18%) were women; most participants were under 65 years of age. More women than men had a primary diagnosis of myocardial infarction (42% versus 28%, respectively), whereas men were more likely than women to have had coronary artery bypass grafting (45% versus 23%, respectively). Men and women had similar mean baseline measures of body mass index, blood pressure and glucose levels, whereas women had significantly higher mean baseline measures of total cholesterol (5.6 mmol/L versus 5.0 mmol/L for men, P 0.001), low density lipoprotein (LDL) cholesterol (3.4 mmol/L versus 3.1 mmol/L, P=0. 012) and high density lipoprotein (HDL) cholesterol (1.2 mmol/L versus 1.0 mmol/L, P 0.001). Baseline LDL to HDL ratios were 3.3 for men and 3.0 for women (not significant), and total cholesterol to HDL ratios were 5.4 and 4.9 for men and women, respectively. Men had a higher exercise capacity than women coming into the program (metabolic equivalent [METs] 6.6 versus 4.9, respectively, P 0.001), had a higher baseline activity level (1114 kcal/week versus 617 kcal/week, P=0.001) and scored higher than women in all health-related quality of life scores. After the program, there were no significant sex differences in improvement in MET level, physical activity or risk factor profile. Although men exercised more than women (increase of 557 kcal/week versus 343 kcal/week, respectively), this was not statistically significant. In health-related quality of life scores, both men and women improved in all scores, although women reported less increase than men in their level of overall vitality (P=0.016). CONCLUSION: Women are the minority of cardiac rehabilitation patients, although they appear to benefit equally well from the program.

Coronary Artery Bypass↗
PubMed2003

The beneficial effects of Tai Chi Chuan on blood pressure and lipid profile and anxiety status in a randomized controlled trial.

OBJECTIVES: To evaluate the effects on blood pressure, lipid profile, and anxiety status on subjects received a 12-week Tai Chi Chuan exercise program. DESIGN: Randomized controlled study of a Tai Chi Chuan group and a group of sedentary life controls. SETTING: Taipei Medical University Hospitals and University campus in the Taipei, Taiwan, area. SUBJECTS: Two (2) selected groups of 76 healthy subjects with blood pressure at high-normal or stage I hypertension. INTERVENTION: A 12-week Tai Chi Chuan exercise training program was practiced regularly with a frequency of 3 times per week. Each session included 10-minute warm-up, 30-minute Tai Chi exercise, 10-minute cool-down. Exercise intensity was estimated to be approximately 64% of maximal heart rate. OUTCOME MEASURES: Blood pressure, lipid profile and anxiety status (State-Trait Anxiety Inventory; STAI) were evaluated. RESULTS: After 12-weeks of Tai Chi training, the treatment group showed significant decrease in systolic blood pressure of 15.6 mm Hg and diastolic blood pressure 8.8 mm Hg. The serum total cholesterol level decreased 15.2 mg/dL and high-density lipoprotein cholesterol increased 4.7 mg/dL. By using STAI evaluation, both trait anxiety and state anxiety were decreased. CONCLUSIONS: This study shows that under well-designed conditions, Tai Chi exercise training could decrease blood pressure and results in favorable lipid profile changes and improve subjects' anxiety status. Therefore, Tai Chi could be used as an alternative modality in treating patients with mild hypertension, with a promising economic effect.

Adult↗
PubMed1995

Preventive interventions with low birth weight premature infants: an evaluation of their success.

The outcome literature on low birthweight (LBW) premature children indicates that they are at risk for a variety of neurodevelopmental impairments throughout childhood. To prevent such disabilities, numerous interventions have been initiated with LBW children. Nineteen intervention programs designed for LBW preterms that have published study results dating from 1971 are reviewed. Included are interventions in the neonatal nursery, at home, and at centers as well as interventions that are both child-focused and parent-focused. One randomized clinical trial evaluating comprehensive intervention services, the Infant Health and Development Program, is described in detail. Conclusions from the studies reviewed indicate that intervention programs have had only modest success in altering neurodevelopmental outcomes, although parent-child interaction has often been facilitated. Future research on the effects of preventive intervention needs to examine long-term developmental competencies and to replicate positive findings in multiple settings.

Female↗
PubMed1998

Staff development in pharmacist-conducted patient education and counseling.

A staff development program designed to improve pharmacists' counseling skills and to allow participants to achieve a minimum level of competence in counseling is described. The pharmacy service at a Department of Veterans Affairs medical center selected a workshop emphasizing the principles of the Indian Health Service (IHS) interactive counseling technique as the basis for a training program for staff pharmacists. The program was expanded to meet the pharmacy's counseling training needs. Handouts on 70 of the most frequently prescribed outpatient medications; administration techniques for oral and nasal inhalers and ophthalmic agents; and 32 common diseases were included in training manuals. Seven standard cases were developed for role-playing sessions, the purpose of which was to increase pharmacists' level of confidence in using the IHS technique and in counseling patients about common diseases and medications. Each pharmacist's counseling technique was assessed by a facilitator. Knowledge of commonly prescribed medications was assessed by an open-book written examination. The pharmacists' self-reported level of confidence in counseling patients about common diseases and medications was significantly improved after the training program. A counseling training program enabled pharmacists to achieve a minimum level of competence in counseling and increased their confidence in their counseling skills.

California↗
PubMed2004

Variations in risk-adjusted outcomes in a managed acute/long-term care program for frail elderly individuals.

OBJECTIVE: To develop and investigate the properties of three performance measures based on risk-adjusted health outcomes for a frail, elderly, community-dwelling population enrolled in a managed, acute, and long-term care program. DESIGN: Retrospective analyses of an administrative dataset containing individual level records with information about socioeconomics, health, functional and cognitive status, diagnoses, and treatments. We estimated risk-adjustment models predicting mortality, decline in functional status, and decline in self-assessed health. Each model includes individual risk factors and indicator variables for the program site in which the individual enrolled. Sites were ranked based on their performance in each risk-adjusted outcome, and the properties of these performance measures were investigated. SETTING: Twenty-eight sites of the Program of All-Inclusive Care for the Elderly (PACE) that provide primary, acute, and long-term care services under capitated Medicare and Medicaid payment to a nursing home certifiable, and functionally and cognitively frail community-dwelling elderly population. STUDY PARTICIPANTS: Three thousand one hundred and thirty-eight individuals who were newly enrolled between 1 January 1998 and 31 December 1999. The average age of these enrollees was 78 years, 27% were male, 50% were diagnosed with dementia, and they had approximately 4 Activities of Daily Living limitations and 7.4 Instrumental Activities of Daily Living limitations. MAIN OUTCOME MEASURES: Risk-adjustment models, performance ranking for each site, and correlations between performance rankings. RESULTS: We present risk-adjustment models for mortality, change in functional status, and self-assessed health status. We found substantial variation across sites in performance, but no correlation between performance with respect to different outcomes. CONCLUSIONS: The variations in outcomes suggest that sites can improve their performance by learning from the practices of those with the best outcomes. Further research is required to identify processes of care that lead to best outcomes.

Activities of Daily Living↗
PubMed1984

Resource guide to occupant protection programs and materials.

This article lists public and private sector associations and organizations concerned with occupant protection. Many of these organizations will provide catalogues and other public information materials on occupant protection. Some have operational programs designed to influence their members in the health professions or the general public. All of the organizations have printed material available. Some provide additional resources on occupant protection such as educational kits, consumer information pamphlets, posters, written testimony, public service announcements, sample legislation, and audio visual aids useful in conjunction with health promotion program development. For information relative to state occupant protection programs, readers should contact their State Office of Highway (Traffic) Safety, Governor's Office, Regional Office of the National Highway Safety Administration, Regional Office of the Department of Health and Human Services, State Health Department or Department of Preventive Health Services, and regional or state affiliate chapters of national organizations, such as the Child Passenger Safety Associations and the National Safety Councils.

Automobiles↗
PubMed1989

Physician participation in prepayment programs for the uninsured.

The problem of the growing number of uninsured increasingly affects physician practices. In Rochester, New York, a cooperative effort between hospitals, physicians, and the Blue Cross and Blue Shield Plan created an insurance program designed for low income uninsured patients. Modified benefits and subsidies from physicians, hospitals and Blue Cross and Blue Shield brought premiums to levels less than half of the rate for unsubsidized coverage. Steps undertaken in the product's development addressed physician concerns, and ensured physician participation sufficient to meet the needs of the program.

Blue Cross Blue Shield Insurance Plans↗
PubMed1989

Clinical career ladders: Jewish Hospital of St. Louis.

The clinical career ladder program developed for pharmacists at Jewish Hospital, a 500-bed tertiary-care teaching institution, is described. In 1983 the hospital's salary structure was re-evaluated. The pharmacy department seized this opportunity to create a clinical career ladder program that would accommodate the changing nature of the profession. Management informally interviewed staff members and developed their opinions into a proposal, which was accepted by the job evaluation committee. The career ladder has three levels. Level I pharmacists carry out basic practice duties. Level II pharmacists have additional responsibilities, notably maintaining a procedure manual, training, and performing an advanced clinical function. At level III, pharmacists develop, implement, and manage a clinical program. Pharmacists are promoted for having achieved a certain level of practice. They are not given new duties upon promotion; rather, they have already taken them on. Advancement can occur at any speed, and it is possible to voluntarily step back to a previous level. The novelty of the program, design flaws, and a series of modifications have created some frustration and confusion among the staff, but the career ladder is otherwise a success. Recruitment has improved, the department's organizational chart is aligned more horizontally, and the pharmacists are being trained for nondistributive roles. In retrospect, management would not have based the program on staff interviews but would have established a formal committee. The effort needed to establish and adjust to a clinical career ladder is great but so is the potential payoff.

Career Mobility↗
PubMed1988

Occupational hearing loss: an aural rehabilitation program for workers and their spouses, characteristics of the program and target group (participants and nonparticipants).

Until very recently, aural rehabilitation programs designed specifically for workers with occupational hearing loss were nonexistent in the Province of Quebec. A pilot study has been conducted to test and develop suitable services for these workers and their spouses, and to explore the factors causing them to seek (or on the other hand, avoid) professional assistance. A trial rehabilitation program was set up for this purpose. Results of a questionnaire conducted among program participants showed that the main factors leading to enrollment in the program were the acknowledgement of moderate or severe hearing handicap and the recognition of the need for help (particularly with problems such as tinnitus and stress, and in using strategies to facilitate communication). These results lend support to the idea of adopting a new approach to rehabilitation services for occupational hearing loss workers. According to the findings of the study, only a very small percentage of workers and spouses participated in the rehabilitation program, despite measures taken to adapt it to their needs. Low enrollment in the rehabilitation program suggests the need for: (1) a more well-defined target population, (2) strategies to promote greater understanding, awareness, and acceptance of hearing handicap on the part of occupational hearing loss workers and peoples surrounding them, (3) education at the work place and in society in general to increase motivation and awareness of the benefits of aural rehabilitation services, (4) integration of the program within the general health program in the work place, (5) measures to enhance the credibility of professionals in the rehabilitation services, (6) general and specific programs and follow-up services, and (7) more accessible services.

Combined Modality Therapy↗
PubMed1980

Involuntary admissions to general hospitals: legal status is not the issue.

Because of California state laws emphasizing treatment at the local level, and because of a number of financial considerations, many general hospitals in California have developed inpatient psychiatric programs designed to meet the needs of all but the most difficult-to-handle patients. Based on their experience in California, the authors argue that general hospitals should not reject involuntary psychiatric patients out of hand simply on the basis of legal status. They suggest instead that a distinction be made between cooperative, participating patients, regardless of legal status, and all other patients, and that appropriate programs be developed for each group. The patient's symptomatology and the resources available on the unit should be the determining factors in admission decisions, not legal status.

California↗
PubMed2006

FlexNovo: structure-based searching in large fragment spaces.

We present a new molecular design program, FlexNovo, for structure-based searching within large fragment spaces following a sequential growth strategy. The fragment spaces consist of several thousands of chemical fragments and a corresponding set of rules that specify how the fragments can be connected. FlexNovo is based on the FlexX molecular docking software and makes use of its incremental construction algorithm and the underlying chemical models. Interaction energies are calculated by using standard scoring functions. Several placement geometry, physicochemical property (drug-likeness), and diversity filter criteria are directly integrated into the "build-up" process. FlexNovo has been used to design potential inhibitors for four targets of pharmaceutical interest (dihydrofolate reductase, cyclin-dependant kinase 2, cyclooxygenase-2, and the estrogen receptor). We have carried out calculations using different diversity parameters for each of these targets and generated solution sets containing up to 50 molecules. The compounds obtained show that FlexNovo is able to generate a diverse set of reasonable molecules with drug-like properties. The results, including an automated similarity analysis with the Feature Tree program, indicate that FlexNovo often reproduces structural motifs as well as the corresponding binding modes seen in known active structures.

Cyclin-Dependent Kinase 2↗
PubMed1991

Electrophoretic gel image analysis software for the molecular biology laboratory.

We present GelReader 1.0, a microcomputer program designed to make precision, digital analysis of one-dimensional electrophoretic gels accessible to the molecular biology laboratory of modest means. Images of electrophoretic gels are digitized via a desktop flatbed scanner from instant photographs, autoradiograms or chromogenically stained blotting media. GelReader is then invoked to locate lanes and bands and generate a report of molecular weights of unknowns, based on specified sets of standards. Frequently used standards can be stored in the program. Lanes and bands can be added or removed, based upon users' subjective preferences. A unique lane histogram feature facilitates precise manual addition of bands missed by the software. Image enhancement features include palette manipulation, histogram equalization, shadowing and magnification. The user interface strikes a balance between program autonomy and user intervention, in recognition of the variability in electrophoretic gel quality and users' analytical needs.

Computer Peripherals↗
PubMed2005

An after-school physical activity program for obesity prevention in children: the Medical College of Georgia FitKid Project.

This article describes the process of setting up a 3-year, school-based after-school physical activity intervention in elementary schools. The primary aim of the study is to determine whether adiposity and fitness will improve in children who are exposed to a fitogenic versus an obesogenic environment. Eighteen schools were randomized to the control (obesogenic) or intervention (fitogenic) group. The study design, program components, and evaluation of the intervention are described in detail. The intervention consists of (a) academic enrichment, (b) a healthy snack, and (c) physical activity in a mastery-oriented environment. Successful implementation would show the feasibility of schools' being able to provide a fitogenic environment. Significant differences between the groups would provide evidence that a fitogenic environment after school has positive health benefits. If feasibility and efficacy are demonstrated, implementing an after-school program like this one in elementary schools could play a major role in preventing and reducing childhood obesity.

Child↗
PubMed2004

Secondary prevention for eating disorders: the impact of education, screening, and referral in a college-based screening program.

OBJECTIVE: The first National Eating Disorders Screening Program (NEDSP), conducted on more than 400 college campuses in 1996, was an educational and two-stage screening program designed to detect potentially clinically significant disordered eating attitudes and behaviors and offer referrals for further evaluation when warranted. The current study assessed the impact of the NEDSP on participants. METHOD: A randomly selected subset of this sample (n = 289) was contacted approximately 2 years after the NEDSP to assess the impact of the program on knowledge and treatment-seeking behaviors for eating disorders. RESULTS: For greater than 80% of the participants, the program made participants aware of the danger of eating disorders and the availability of treatment. Of those who received a recommendation for further clinical evaluation of disordered eating (n = 109), nearly one half (47.7%) followed up on this recommendation and kept at least a first appointment and 39.4% actually sought treatment subsequent to the NEDSP. DISCUSSION: The results of the current study suggest that educational and screening programs may be a promising strategy for secondary prevention of eating disorders. They also suggest that awareness of the risks of disordered eating and available treatment may not be sufficient to motivate individuals to adhere to recommendations to seek treatment. Clinicians should, therefore, be vigilant for nonadherence to treatment recommendations and proactive in facilitating treatment.

Adolescent↗
PubMed1998

Distributed parallel processing for multidimensional maximum entropy reconstruction.

We have developed a two-dimensional maximum entropy spectrum reconstruction program designed to run in parallel on workstation clusters. Test reconstructions of planes extracted from a three-dimensional NMR data set indicate that the parallel speedup is nearly equal to the number of processors provided that the individual processors have comparable performance and that there are at least as many planes as processors. The program also works well in a typical laboratory setting consisting of heterogeneous workstations.

Algorithms↗