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Inhibitor binding to active and inactive CDK2: the crystal structure of CDK2-cyclin A/indirubin-5-sulphonate.

BACKGROUND: Cyclin-dependent kinase 2 (CDK2) is an important target for structure-based design of antitumor agents. Monomeric CDK2 is inactive. Activation requires rearrangements to key structural elements of the enzyme's active site, which accompany cyclin binding and phosphorylation. To assess the validity of using monomeric CDK2 as a model for the active kinase in structure-based drug design, we have solved the structure of the inhibitor indirubin-5-sulphonate (E226) complexed with phospho-CDK2-cyclin A and compared it with the structure of E226 bound to inactive, monomeric CDK2. RESULTS: Activation of monomeric CDK2 leads to a rotation of its N-terminal domain relative to the C-terminal lobe. The accompanying change in position of E226 follows that of the N-terminal domain, and its interactions with residues forming part of the adenine binding pocket are conserved. The environment of the ATP-ribose site, not explored by E226, is significantly different in the binary complex compared to the monomeric complex due to movement of the glycine loop. Conformational changes also result in subtle differences in hydrogen bonding and electrostatic interactions between E226's sulphonate and CDK2's phosphate binding site. Affinities calculated by LUDI for the interaction of E226 with active or inactive CDK2 differ by a factor of approximately ten. CONCLUSIONS: The accuracy of monomeric CDK2 as an inhibitor design template is restricted to the adenine binding site. The general flexibility observed for the glycine loop and subtle changes to the phosphate binding site suggest a need to study interactions between inhibitors and active CDK2 in structure-based drug design programs.

CDC2-CDC28 Kinases↗

Overview of EPA Superfund human health research program.

This paper presents major research needs for the Superfund program, and provides an overview of the EPA Office of Research and Development's (ORDs) current human health research program designed to fill some of those data gaps. Research is presented in terms of the risk paradigm and covers exposure, effects, and assessment activities directly funded by Superfund, as well as research not funded by Superfund but directly applicable to Superfund research needs. Research on risk management is not covered. Current research activities conducted by the Superfund program office are also included to provide a full picture of Superfund human health research activities being conducted by EPA.

Environmental Exposure↗

Changing medical students' attitudes about older adults and future older patients.

BACKGROUND: An important step in educating future physicians to care for older patients is to diminish the influence of negative stereotypes they often hold about older people. This study presents outcomes of a mentors-on-aging program designed to promote positive attitudes toward older adults and older patients among medical students. METHOD: A pretest, posttest, control group design, with survey data, was used. RESULTS: Analysis of students' preprogram responses compared to postprogram responses indicated that their attitudes did improve. Furthermore, the students' postprogram attitudes toward older adults were more positive than the control group's; however, their attitudes toward older patients did not differ from the control group. CONCLUSIONS: A mentors-on-aging program offering students interaction with healthy, active older adults can help students to acquire positive attitudes toward older people. More targeted experiences with generally healthy older people as patients may be needed to significantly improve students' attitudes toward older patients.

Adult↗

Important computer competencies for the nursing profession.

Nursing requires computer competencies. This study aimed at identifying those competencies required for the nursing profession in Taiwan. The Delphi technique was deployed in this study. In the Delphi questionnaires, computer competencies were sorted into seven domains: concepts of hardware, software, and networks; principles of computer applications; skills of computer usage; program design; limitations of the computer; personal and social issues; attitudes toward the computer. In three Delphi questionnaires, nursing informatics experts gave us their opinions on the importance of each computer competency for the nursing profession. The experts also designated when the competency should be cultivated. This study provides a comprehensive list for nursing professionals to check on their computer competence. The results of this study should also serve as good references for teachers and schools in designing related curriculums.

Adult↗

Results after 3 years of non-operative occlusal caries treatment of erupting permanent first molars.

The aim of the study was to describe the 3-yr results of a treatment program designed to control occlusal caries on the basis of intensive patient education and professional toothcleaning. The sample consisted of 56 children 6-8 yr old with their permanent right first molars in different stages of eruption. The results were compared with record data from 58 children of the same age who had received a traditional caries treatment program including fissure sealing (control group). After 1 yr a significant reduction of occlusal surfaces with visible plaque was noted in the study group as well as an increased proportion of arrested lesions. These results were maintained after 2 and 3 yr. Ten (9%) teeth were sealed and one filled during the study period. Examination of record data in the control group over a 3-yr period revealed that 76 (65%) first molars were sealed and 7 (6%) were filled. During the first year 1/3 of the children in the study group needed 5-6 recall visits, whereas in the following period all children were only seen 1-4 times. In contrast, 50% of the children in the control group needed 5-6 recalls in the 3rd yr. Our data indicate that professional care for erupting teeth on an individual basis has a long-term effect on occlusal surfaces as well. The alternative technique required less clinical time than the traditional application of sealants.

Child↗

Pediatric asthma program reaches the youngest patients.

Asthma attacks can set pre-schoolers and their parents into a panic. A new program designed just for kids ages 4-8 shows that even the youngest patients can be taught to control their asthma with the right education and tools.

Adolescent↗

Computer aided technical instruction, (C.A.T.I.).

The article refers to the development of several computer programs designed to fulfil the role of teaching aids in relation to the technological aspects of dentistry. The hardware used was a BBC Master computer, this being a deliberate choice, to demonstrate that it is not necessary to have state of the art computer technology in order to produce very satisfactory computer aided technical instruction packages. All the programs were written in BBC Basic. Computer graphics illustrate and simplify dynamic concepts involved in dental technology. The programs having been developed in house proved to be inexpensive, in addition the program structure allows for easy upgrading. An extract from one of the procedures that serves to make up the modules is included to demonstrate the simplicity of the programming and the modular concept of program development.

Computer Simulation↗

The impact of clinical information systems research on the future of advanced practice nursing.

Expert systems are "intelligent" computer programs designed to mimic the decision making of a human expert. This article describes two formal evaluations of one of the first nursing expert systems. Initial results were positive, however, subsequent analysis identified significant limitations in the ability of the expert system to mimic the consultation process of advanced practice nurses (APNs). Because few newly developed systems are being subjected to a clinical trial or to the scrutiny reported here, developing systems may prove to be cost inefficient over time. APNs must be actively involved in the design, development, and evaluation of all nursing expert systems.

Expert Systems↗

Smoking cessation programs in the workplace. Review and recommendations for occupational health nurses.

The worksite offers occupational health nurses unique opportunities to assist workers in their smoking cessation efforts. For nurses to be effective in this endeavor, they must be knowledgeable about the various quit smoking strategies that have met with some success. Based on the review of the research, there is no "magic bullet" to offer smokers who want to quit. Occupational health nurses have an opportunity, therefore, to use multiple approaches and design programs to fit the specific needs of the smokers in their practice. Published reports of nurses' involvement in workplace smoking cessation programs are sparse. It is crucial that occupational health nurses spearhead smoking cessation efforts at the workplace and communicate the results of these enterprises.

Humans↗

Outcomes of a disease-management program for patients with recent osteoporotic fracture.

INTRODUCTION: The purpose of this study was to evaluate outcomes of a disease-management program designed to increase rates of bone-mineral-density (BMD) testing and initiation of osteoporosis medication among patients with a recent osteoporotic fracture. STUDY DESIGN: We identified 744 consecutive patients aged>or=55 years who were seen at either of 2 of 14 Kaiser Permanente medical facilities in Northern California (KPNC) after sustaining a fracture of the hip, spine, wrist, or humerus between April 2003 and May 2004. These patients were invited to participate in a study of the Fragile Fracture Management Program, whose protocol used fracture-risk assessment tools to determine treatment recommendations. Postfracture care of study participants was compared with usual postfracture care received by osteoporotic-fracture patients at 12 other KPNC facilities. RESULTS: Of the 744 patients who were invited to participate in the study, 293 (39%) agreed to participate, and 169 (23%) completed the evaluation. Of these 169 patients (127 women, 42 men), 65 (51%) of the women and 7 (17%) of the men qualified for drug treatment; of these 72 patients, 6 (86%) of the men and 41 (63%) of the women accepted the offered treatment. At the two study locations, rates of care (BMD testing or prescribing osteoporosis medication) were about twice as high as rates of usual postfracture care observed at 12 other medical centers in KPNC. CONCLUSIONS: Compared with patients who received usual care for osteoporotic fracture, patients participating in a postfracture disease management program had substantially higher rates of medical attention given for osteoporosis; however, the overall yield of the program was low. This low uptake rate was related to factors not previously appreciated: many patients refused participation in the program; a high proportion of younger women-and men of all ages-did not qualify for treatment; and treatment was refused by one in three study-qualified women and by one in seven study-qualified men. Additional efforts are needed to overcome patient barriers to improved osteoporosis evaluation, treatment and participation in postfracture programs.

Absorptiometry, Photon↗

Computer methodology for simulation and prediction of alloimmune responses: expected antibody specificities.

The methodology presented here was developed for simulating planned alloimmunization results, with regard to the type and number of expected antibody specificities. The computer program designed for this purpose was adapted to an immunogenetic model using Boolean algebra. It was written to help immunogeneticists avoid handling routine data preceding selection of donor-recipient pairs, specially concerning blood type alloimmunizations in animals: all of the donor-recipient combinations and the expected antibody specificities (their limit number being specified in each particular immunization program) are provided in the print-out.

Animals↗

To what extent are key services offered in treatment programs for special populations?

Many substance abuse treatment (SAT) facilities offer programs designed specifically for special populations such as women, adolescents, gays/lesbians and others. Previous research shows that there are specific services that are integral to the successful treatment of these populations (e.g., family therapy for adolescents, childcare and transportation assistance for women, and HIV testing and counseling for gays/lesbians). This study examines whether facilities that self-report having programs for special populations actually offer the recommended services. The data come from the 2000 National Survey of Substance Abuse Treatment Services, which contains information on service offerings, special programs and other characteristics for all SAT facilities in the USA. The results indicate that facilities with special programs are more likely to offer the recommended key services. However, often less than half of these facilities provide the key services. There are consistent differences by ownership status, with for-profit facilities less likely to offer many of the key services.

Adolescent↗

Weighted stair climbing in mobility-limited older people: a pilot study.

OBJECTIVES: To evaluate weighted stair climbing exercise (SCE) as a means of increasing lower extremity muscle power in mobility-limited older people. DESIGN: Single-blinded, randomized controlled pilot study. SETTING: Human physiology laboratory of a metropolitan university. PARTICIPANTS: Forty-five community-dwelling people aged 65 and older who had baseline mobility limitations manifested by scores of 11 or lower on the Short Physical Performance Battery (SPPB). INTERVENTIONS: Subjects were randomized into one of two 12-week exercise programs. The intervention group (SCE) (n = 23) ascended and descended stairs, at a set pace, while wearing a weighted vest. The control group (WALK) (n = 22) participated in a standardized walking program. MEASUREMENTS: Primary and secondary outcomes included measures of muscle power and strength, submaximal aerobic capacity, and physical performance. RESULTS: SCE produced 17% improvement in double leg press peak power in comparison with WALK (P =.013) and significant improvement in stair climbing power from baseline (12%). Improvement in submaximal aerobic performance was equivalent for both groups. Although not statistically significant, effect size estimates suggest that SCE can potentially influence knee extension power and strength. Stair climb time was improved in both groups, whereas SCE produced significant improvements from baseline SPPB score in a subcohort of participants. CONCLUSIONS: These findings suggest that SCE maybe a useful component of a home exercise program designed to enhance lower extremity muscle power, aerobic capacity, and functional performance. Further investigation is needed involving larger sample sizes and direct comparisons with other forms of resistance training.

Aged↗

[A study of computer-aided drawing system for individualized ideal arches].

OBJECTIVE: The aim of this study is to devise a computer aided drawing system for individualized ideal arches, to resolve the discommode of manual drawing of Bonwill-Hawley arch charts and and to avoid the non-matching problem when using the universal arch charts. METHODS: On the basis of drawing principle of Bonwill-Hawley individualized ideal arches, the computer program was written with Visual Basic version 6.0. RESULTS: The new computer-aided drawing system of individualized ideal arches was based on Windows9X/NT. After the data of mesiodistal diameters of maxillary anterior teeth crown (from mesial surface to distal surface of bracket for canine) were input, a matching individualized ideal arch chart would be drawing using the designed program immediately. CONCLUSION: The computer-aided drawing system of individualized ideal arch can help to draw a matching individualized ideal arch accurately and quickly. This system eliminates the complex and cockamamie process of manual drawing.

Computer Graphics↗

Making cancer prevention effective for African-Americans.

In order to reduce the racial disparities in cancer death rates, prevention programs designed for minorities must concentrate on the cancer sites and intervention methods which offer the greatest promise for closing the mortality gap. Generally accepted methods to achieve these results were recently published by the U.S. Preventive Services Task Force. Effective intervention recommendations will be increased when researchers understand the cultural differences of minorities, communicate clearly, collaborate with other programs, and treat the program participants with respect.

Adult↗

Meaningful rehabilitation of the end-stage renal disease patient.

In this highly technological age, health care providers are called to attend to the patient as a whole person, with dreams and goals and a desire for purpose and meaning in life. In this article, we propose a broadened definition of rehabilitation and a rehabilitation program designed to effect an improvement in the quality of life of each renal patient by aiming to restore meaningful existence in each of their lives. An individualized plan for rehabilitation can be constructed and implemented with far-reaching success when the focus is on the life goals of the patient, whether physical, social, psychological, or intellectual. These programs not only enhance the quality of life of the patient with end-stage renal disease, but are cost-effective, both at the societal level and at the level of the dialysis clinic.

Cost-Benefit Analysis↗

The political economy of federal health programs in the United States: an historical review.

In the 1960s the federal government of the United States added a wide range of new health programs--Medicare, Medicaid, health manpower training, occupational safety, and others--to its long-established support for biomedical research and hospital construction. Total federal health outlays rose from $5 billion in 1965 to almost $37 billion in 1975. This paper describes the legislative history of federal health programs and reports the recent trends in expenditures by functional category. The expenditures of major programs are related to the populations they serve and data are presented to document the enormous inflow of resources to medical care during the last 10 years. This inflow has been induced by the structural changes in the medical care market first set in motion by private health insurance, and accelerated by the new federal programs. Designing some way to control it is a major problem in health policy for the late 1970s.

Economics↗

Inservice education: a commitment to excellence.

An inservice education program was initiated in the Clinical Hematology laboratory at McMaster University Medical Centre, a division of Chedoke-McMaster Hospitals, in September 1987. Clinical Hematology staff work in the Hematology, Coagulation or Transfusion Medicine departments. Approximately 30 staff members, one of whom serves as an educational co-ordinator, are participants in the program. Goals for the program were set during the first year. Both formative and summative evaluation procedures are used to monitor achievement of these goals. Formative evaluation consists of audience reaction forms which are completed by participants at each session. This enables the co-ordinator to change the program during the year. Summative evaluation is a comprehensive look at the program. Questionnaires are used to solicit the participants' response to the program, and an interview is used to obtain feedback from the chief technologists. An evaluation report was generated at the end of each year of the program. Program design, goal structure and evaluation procedures are outlined. Partial results from three years of evaluation are also presented.

Data Collection↗