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PubMed1994

Demonstration of a neural network expert system for recognition of glaucomatous visual field changes.

Expert systems (ESs) are computer programs designed to make decisions in a manner similar to the way human experts make them. There are many forms of ESs, ranging from those that are given specific If-Then rules to those that are capable of deriving their own rules. Some ESs use neural network simulations to analyze patterns of data. In this project, a commercially available neural network shell program was used to demonstrate the development of an ES capable of analyzing the visual field loss patterns produced by glaucoma. Potential applications of ESs for the diagnosis of glaucoma are discussed.

Decision Making, Computer-Assisted↗
PubMed1998

Placing the cornerstone for healthcare professionals' risk management education: an educational needs assessment.

The risk manager's performance of an educational needs assessment to assist in determining related training and development elements supports a solid, proactive risk management program designed to motivate healthcare professionals. Environmental scanning, needs assessment tool design and development, tool validation, organizational commitment and ethical considerations are examined. A sample needs assessment tool is provided.

Delivery of Health Care, Integrated↗
PubMed1989

The B6.SW bilineal congenic sucrose octaacetate (SOA)-taster mice.

SWR/J inbred mice (Tasters) reliably avoid, whereas C57BL/6J inbred mice (Nontasters) are indifferent to, sucrose octaacetate (SOA) at certain concentrations. From these strains we have developed a set of bilineal congenic Taster mice. Approximately 4000 mice, from 2 isogenic and 12 segregating generations, were tested in a program designed to evaluate genetic models for SOA tasting during development of congenic strains. The criterion phenotype was avoidance or nonavoidance in preference tests of the bitter tastant SOA at concentrations of 10(-4) and 10(-5) M. Across the 12 segregating generations, the results were consistent with Mendelian expectations for a single autosomal locus with complete dominance of the Taster phenotype. The breeding program produced 12 replicate B6.SW lines containing the taster allele on the B6-Nontaster genomic background. The congenic Taster mice may facilitate a functional analysis of the sense of taste.

Animals↗
PubMedDate not supplied

Food advertising in the age of obesity: content analysis of food advertising on general market and african american television.

OBJECTIVE: To document the types of foods advertised and weight-related nutritional claims made during advertisements appearing on general market and African American television programming. DESIGN: Content analysis of 553 food advertisements appearing during 101.5 prime-time television hours. OUTCOME MEASURES: Advertisements were classified according to general category (fast-food restaurant, sit-down restaurant, packaged food), specific food type, and the presence of a weight-related nutritional claim. ANALYSIS: The type of foods advertised and nutritional claims made on general market and African American programs were compared using t and chi-squared tests. RESULTS: More food advertisements appeared during African American programs than general market programs. These advertisements were more likely to be for fast food, candy, soda, or meat and less likely to be for cereals, grains and pasta, fruits and vegetables, dessert, or alcohol. Of all of the food advertisements, 14.9% made a weight-related nutritional claim. More claims related to fat content appeared during African American programming, whereas more light and lean claims appeared in general market advertisements. CONCLUSIONS AND IMPLICATIONS: Practitioners and policy makers should be aware of the prevalence of food advertisements and their potential impact on knowledge and behavior and should consider working more closely with food manufacturers to encourage the creation and promotion of weight-friendly foods. Meanwhile, nutrition educators can help by teaching consumers critical thinking skills as may relate to food advertisements.

Advertising↗
PubMed2001

Nutrient management programs, nitrogen fertilizer practices, and groundwater quality in Nebraska's Central Platte Valley (U.S.), 1989-1998.

Given the societal concern about groundwater pollution from agricultural sources, public programs have been proposed or implemented to change farmer behavior with respect to nutrient use and management. However, few of these programs designed to change farmer behavior have been evaluated due to the lack of detailed data over an appropriate time frame. The Central Platte Natural Resources District (CPNRD) in Nebraska has identified an intensively cultivated, irrigated area with average groundwater nitrate-nitrogen (N) levels about double the EPA"s safe drinking water standard. The CPNRD implemented a joint education and regulatory N management program in the mid-1980s to reduce groundwater N. This analysis reports N use and management, yield, and groundwater nitrate trends in the CPNRD for nearly 3000 continuous-corn fields from 1989 to 1998, where producers faced limits on the timing of N fertilizer application but no limits on amounts. Groundwater nitrate levels showed modest improvement over the 10 years of this analysis, falling from the 1989-1993 average of 18.9 to 18.1 mg/l during 1994-1998. The availability of N in excess of crop needs was clearly documented by the CPNRD data and was related to optimistic yield goals, irrigation water use above expected levels, and lack of adherence to commercial fertilizer application guidelines. Over the 10-year period of this analysis, producers reported harvesting an annual average of 9729 kg/ha, 1569 kg/ha (14%) below the average yield goal. During 1989-1998, producers reported annually applying an average of 162.5 kg/ha of commercial N fertilizer, 15.7 kg/ha (10%) above the guideline level. Including the N contribution from irrigation water, the potential N contribution to the environment (total N available less estimated crop use) was estimated at 71.7 kg/ha. This is an estimate of the nitrates available for denitrification, volatilization, runoff, future soil N, and leaching to groundwater. On average, between 1989-1993 and 1994-1998, producers more closely followed CPNRD N fertilizer recommendations and increased their use of postemerge N applications--an indication of improved synchrony between N availability and crop uptake.

Agriculture↗
PubMed2002

Using recidivism data to evaluate project safecare: teaching bonding, safety, and health care skills to parents.

Project SafeCare was an in-home research and intervention, grant-funded program designed to teach parents who were reported for child abuse and neglect. Parents who participated in Project SafeCare received training in three aspects of child care: treating illnesses and maximizing their health-care skills (health), positive and effective parent-child interaction skills (bonding), and maintaining hazard-free homes (safety) for their children. Postcontact (after initial intake was made and the program began) incidents of child abuse and neglect for maltreating parents who participated in and completed Project SafeCare were compared to a comparison group of maltreating families from the point of initial intake through a 24-month follow-up period. The comparison group (referred to as the Family Preservation group) received intervention from Family Preservation programs. Families who participated in Project SafeCare had significantly lower reports of child abuse and neglect than families in the comparison group.

Adult↗
PubMed1996

Academic-community linkages: community-based training for family physicians.

BACKGROUND: Community-based curricular experiences have been proposed to fulfill the graduate training needs of future family physicians. Are such experiences feasible? How can such experiences be started? What outcomes can be expected? METHODS: We describe 15 years' experience with community-based training in family practice graduate medical education at UMDNJ-Robert Wood Johnson Medical School. We also describe the process of creating academic-community linkages using stakeholder management and the resultant programs that evolved to fulfill specific training requirements. RESULTS: Five of the curricular programs designed are described, four of which were successful. Community-based training enhanced recruitment of students of minority background into the residency, and a high proportion of residency graduates have established practices in communities with underserved populations. CONCLUSIONS: Community-based training of family physicians is a feasible and effective means of addressing unmet health needs of communities served by graduate medical education programs and their related health care institutions.

Ambulatory Care↗
PubMed2004

COR V2: teaching observational research with multimedia courseware.

Courseware for Observational Research (COR Version 2) is an interactive multimedia program designed to teach the foundation of the scientific method: systematic observation. COR uses digital video with interactive coding to teach basic concepts, such as creating precise operational definitions; using frequency, interval, and duration coding; developing sampling strategies; and analyzing and interpreting data. Through lessons, a case study, and laboratory exercises, it gradually scaffolds students from teacher-directed learning into self-directed learning. The newest addition to COR is a case study in which students work collaboratively, using their own observations to make recommendations about a child's disruptive behavior in an after-school program. Evaluations of the lessons showed that classes using COR received better grades on their field observations than did those using methods that are more traditional. Students' confidence and knowledge increased as they moved through each section of the program.

Child↗
PubMed1991

Needlestick injury: impact of a recapping device and an associated education program.

OBJECTIVE: To determine the impact of the introduction of a plastic shield-shaped device (Needleguard, Biosafe, Auckland, New Zealand) and education program designed to allow safer recapping, on recorded rates of needlestick injury. DESIGN: A before-after trial with a two-year duration of follow-up. SETTING: Tertiary referral hospital. PARTICIPANTS: Nursing and other hospital personnel. RESULTS: Prospectively collected baseline data, together with the results of an anonymous questionnaire of 25% of the hospital nursing staff, defined a reported needlestick injury rate of 6.9 per hundred full-time nursing staff per year. In the pre-intervention period, there were 6.7 needlestick injuries per 100 nursing staff members per year reported. This increased to 15.4 (p less than .0001) needlestick injuries per 100 nursing staff members per year after the intervention. An anonymous survey undertaken at both time periods suggests that the apparent increase in officially reported needlestick injuries is due to an increase in the willingness of nurses to now report previously unreported needlestick injuries. CONCLUSIONS: The impact of the safety device and education program was the more accurate reporting of needlestick injuries; many nursing staff continued to resheath needles contrary to hospital policy. Many staff simply did not use the newly designed safety device. Approaches to improving compliance with such safety devices are considered.

Accidents, Occupational↗
PubMed1980

Verification and standardization of cephalometric coordinate data.

This paper presents the details and logic of the FORTRAN computer programs designed to verify the accuracy of digitized coordinate data arising form cephalometric radiographs, prior to entry into a databank. In addition, the software accounts for varying magnifications of the radiographs which result from the use of different cephalometers, Finally, data from all records are oriented in the same coordinate system, thus standardization of the data has been accomplished. As a result of the two programs, the user may be guaranteed accurate and comparable data for any or all records contained in the databank.

Cephalometry↗
PubMed1988

Computer simulation of high-performance liquid chromatographic separations of peptide and protein digests for development of size-exclusion, ion-exchange and reversed-phase chromatographic methods.

A computer program, called Pro Digest-LC, has been developed which assists scientists in devising methods of size-exclusion, cation-exchange and reversed-phase high-performance liquid chromatography for the analytical separation and purification of biologically active peptides and peptide fragments from enzymatic and chemical digests of proteins. Pro Digest-LC accurately predicts the retention behaviour of peptides of known composition, containing 2-50 amino acid residues, and simulates the elution profiles in all three modes of chromatography. In addition, Pro Digest-LC is a user-friendly program, designed as a teaching aid for both students and researchers in selecting the correct conditions for chromatography, that is, the mode of chromatography, column selection, mobile-phase selection, and has the ability to examine the effects of flow-rate, gradient-rate, and sample size on the separation. We have designed a set of peptide standards for each mode of chromatography to aid the researcher in eliminating non-specific interactions, to standardize retention behaviour on the user's columns, to monitor column performance and to compare packing materials. In the development of each prediction mode, experimental peak heights, peak widths, and retention times from model synthetic peptide standards were incorporated directly into the program and can be used as default values. Pro Digest-LC is an interactive program, in that researchers can run peptide standards on their particular columns and enter the peak width at half-height, peak height, retention time and quantity injected to adjust the simulation to their particular column. The simulated experiments eliminate the time-consuming trial-and-error methods used to suitable separation or purification procedures. The researcher would perform the actual experiment only after predicting the optimized conditions, thereby saving valuable sample and research time. The general concepts of the program along with representative separations of protein digests are displayed.

Animals↗
PubMed1997

VLCD plus dietary and behavioural support versus support alone in the treatment of severe obesity. A randomised two-year clinical trial.

OBJECTIVES: To determine whether 12 initial weeks on a Very Low Calorie Diet (VLCD) included in a two-year support program is associated with better long term weight loss maintenance than a dietary and behavioural support program alone. Additionally, to identify characteristics associated with successful treatment or attrition, which can be used in selecting individuals likely to respond to VLCD-programs. DESIGN: Randomised clinical trial. SETTING: Two Swedish out-patient clinics. SUBJECTS: 113 obese men and women aged 37-58 y, body mass index (BMI) > 32.0 kg/m2, participating in the Swedish Obese Subjects-(SOS) study. INTERVENTIONS: One group received VLCD for 12 initial weeks plus regular dietary and behavioural support over two years while the other group received two years of the same supportive program only. MAIN OUTCOME MEASURE: Weight loss after two years treatment. RESULTS: Both treatment groups maintained highly significant weight losses at two years but the initial VLCD-treatment appeared to have given no significant long term benefit compared to the supportive program. Examination of selected demographic, psychosocial and dietary characteristics showed that the VLCD-approach was more effective than the supportive strategy alone in men and possibly in individuals sharing household with only one person. High initial hunger-score was associated with attrition, irrespective of treatment. CONCLUSION: A VLCD-program including long term dietary and behavioural support is a successful treatment for some severely obese subjects, especially men. Further research should be directed towards matching treatments to individuals in order to improve the high recidivism rates generally following weight loss attempts.

Adult↗
PubMed2006

Multidimensional exercise for people with Parkinson's disease: a case report.

The primary impairments associated with Parkinson's disease occur in combination with the secondary, preventable effects of immobility. A community-based fitness program may help increase activity and maintain function in people in the early or middle stages of the disease. This article describes a unique program designed to reduce fall risk and promote independent exercise for people with Parkinson's disease. Two 66-year-old males, both community ambulators and in early or middle stages of Parkinson's disease, participated in 3 months of various physical activities. Group balance classes were held twice weekly during the first month, participants joined a fitness center and self-directed their exercise program during the second month, and group Tai Chi classes were held twice weekly during the third month. At conclusion of the program, participants were given suggestions for continued physical fitness activities. After the 3-month program, improvements were noted for both individuals in functional reach, Timed Up and Go, and Berg Balance scores. Both participants continued to exercise regularly for at least 8 months following the program. Two individuals with Parkinson's disease demonstrated improvement in their balance test performance over a 3-month period. Perhaps most importantly, these participants independently continued exercising after completing this program.

Aged↗
PubMed2002

Development of a culturally sensitive educational intervention program to reduce the high incidence of tuberculosis among foreign-born Vietnamese.

OBJECTIVE: In Los Angeles County and Orange County, 98% of Asians with tuberculosis (TB) were foreign born; newly arrived Vietnamese immigrants had the highest TB risk: i.e. > 100 times higher than that of the USA. The study objective was to find ways to reduce the high incidence of tuberculosis among the Vietnamese by: (1) identifying and understanding the cultural health beliefs and barriers among the Vietnamese population of Orange County, California; and (2) developing a partnership between UCLA/VA/RAND MEDTEP, key Vietnamese community-based organizations, and community leaders in Orange County to develop and implement a comprehensive, culturally sensitive educational intervention program. DESIGN: Vietnamese residing in Orange County were recruited to obtain qualitative and quantitative data in 1998 and 1999, respectively. The study design included focus groups, in-depth interviews, and community surveys. Data were collected via qualitative reports, computer-assisted random telephone interviews, and self-administered questionnaires. RESULTS: A conceptual schema was identified within the Vietnamese health belief system that recognized two different forms of tuberculosis: non-infectious psychological and infectious physical tuberculosis. It was possible to engage community organizations in developing programs to combat TB in the Vietnamese population. CONCLUSION: The Health beliefs of Vietnamese will be important considerations in developing a culturally sensitive educational intervention program to service this at-risk population.

Asian↗
PubMed2002

Teaching the teachers: helping faculty in a family practice residency improve their informatics skills.

Faculty members in family practice residencies are increasingly being asked to help residents develop skills in the use of informatics and evidence-based medicine (EBM). In order to do this successfully the teachers themselves must be skilled in the use of these tools. Recognizing the need for such training, the Maine Medical Center Family Practice Residency Program designed a faculty development project to increase knowledge and skills in the use of information technology. This project, which was carried out in 1999-2001, utilized a multifaceted approach that included improving the residency's technology infrastructure, conducting two instructional workshops, and offering EBM mentoring for preceptors. Faculty members also designed and carried out independent informatics projects. Pre- and post-project assessments of faculty members demonstrated a significant improvement in computer and EBM skills, and informal feedback from residents indicates that these skills have been successfully applied to the faculty members' teaching of residents and their practice of family medicine. This project had a positive impact on the faculty members in the residency program, increasing both their ability to employ information technology in individual and group teaching sessions and their use of EBM in clinical practice. Also, the culture within the residency program has been changed to one of utilizing computers and the Internet as principal resources for up-to-date information.

Curriculum↗
PubMed1995

The Jamaican Diabetes Survey. A protocol for the Caribbean.

OBJECTIVE: This study was designed to investigate the point prevalence of diabetes in Jamaica. RESEARCH DESIGN AND METHODS: A two-stage stratified random sampling design was used, and individuals aged 15 years and over were interviewed. Nonresponse was documented and factored into the final analysis of the survey data. The overall response rate obtained was 57.9%. All subjects with fasting blood glucose (FBG) greater than 6.1 mmol/1 (110 mg/dl) were brought back for an abbreviated glucose tolerance test. The data was analyzed using Epi 5, an advanced statistical program designed specifically for use with epidemiological data. RESULTS: The 2,109 subjects who participated were the basis for estimates of diabetes and IGT prevalence. Among those with previously diagnosed diabetes, diet therapy alone, oral hypoglycemic agents plus diet therapy, insulin therapy, and lack of treatment were reported. CONCLUSIONS: By the World Health Organization (WHO) criteria, Jamaica has a point prevalence of diabetes of 17.9% in the 15-and-over age-group.

Adolescent↗
PubMed1995

Pharmacotherapy quality improvement in the managed care setting.

Physician partnering, value-added relationships, and integrated delivery systems with risk/incentive arrangements are emerging in managed care. These arrangements require time-sensitive program information that can be used in continuous quality improvement programs. Components of any clinical intervention program designed to improve the quality of pharmacotherapy are on a continuum, from those that are primarily individual patient focused to those that are disease or system/process focused. Components include case management, patient profile review, brand to generic drug conversion, targeted therapeutic evaluations, provider profiling, and pharmacoeconomic analysis. All health care professionals involved in pharmacotherapy need to be involved in implementation of these quality improvement programs.

Cost Control↗
PubMed1973

Nurse practitioners in primary care. 3. The southern Ontario randomized trial.

A group of nurses who formerly had performed office functions received a special university-based educational program designed to prepare them to assume much of primary care management as nurse practitioners. The associated family physicians would shift their role to general supervision and attention to difficult clinical problems. To test this new form of practice, two complementary randomized trials have been conducted in south-central Ontario. The particular trial reported here was intended to assess the influence of the educational program on the changing roles of the professional personnel. The nurses of 14 family medical practices, with the physicians' support and commitment to participation, applied for the new training. Seven applicants were randomly selected to receive the training and their corresponding practices became the experimental group, while the remaining nurses and practices were retained as controls. During the subsequent year of investigation important changes occurred in professional roles of the experimental group. Nurse practitioners spent more time in clinical activities than conventional office nurses. The shift was not at the expense of time devoted to clinical work by physicians. Doctors delegated more professional activities to nurse practitioners than to conventional nurses. Except for remuneration (affected by legal constraints) job satisfaction among experimental physicians and nurses remained high after one year of experience with the new method.

Attitude of Health Personnel↗