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PubMed1997

Parallel distributed processing and executive functioning: Tower of Hanoi neural networkmodel in healthy controls and left frontal lobe patients.

Previous clinical studies have demonstrated that executive functioning has a significant association with the frontal lobes. In this study we examined executive functioning with parallel distributed processing (PDP) methodology by attempting to replicate Tower of Hanoi (TOH) neuropsychological test performance differences in normal healthy controls vs. left frontal lobe patients. Initial theoretical experiments were carried out to solve computer subprocessing constraints of the TOH partially by determining the programming prerequisites for a specific number of rings, efficient sequencing, and a general learning rule. These preliminary studies were then modified using a back-propagation neurocomputational approach. Computer program output showed a resemblance to normal controls' TOH moves. Degrading of the left frontal lobe patients' network resulted in characteristic impairments of executive functioning, i.e., perseveration and rule-braking.

Algorithms↗
PubMedDate not supplied

Establishing national health goals and standards.

Four statements of national health goals and standards were proclaimed from the U.S. Department of Health and Human Services during the 1970s. Two were based on statutory mandates--the National Guidelines for Health Planning and the Model Standards for Community Preventive Health Services. Two were the results of administrative initiatives--the Forward Plans for Health and the complementary publications "Healthy People" and "Promoting Health/Preventing Disease". These efforts present a variety of approaches and experiences and can provide direction and lessons for future endeavors along these lines. The four issuances include guidance on national priorities, resource standards, and accessibility to care. They also offer goals and objectives for local services and health status. They address a multiplicity of issues, ranging from hospital bed supply and recommended uses of specialized medical equipment to infant mortality and proposed reductions in death and disability. Almost all urge further actions to prevent illness and promote health. The development of statements of national health goals and standards has been advocated by some experts and questioned by others. Advocates believe that these materials can help clarify purposes and priorities for health programs, resulting in more effective and efficient uses of resources and greater accountability. Critics are particularly concerned about deleterious impacts on creativity and local initiatives. Among the major lessons identifiable from these undertakings is the importance of committed leadership, broad-based consultation, and reliable data. Implementation inevitably encounters the complexities of the health system and depends upon available resources. In influencing the agenda of deliberation and debate, the symbolic value of these statements may often be more significant than the specific details. The continuing interest in these approaches suggests that future efforts along these lines are likely.

Adolescent↗
PubMed1999

Ribosomal protein L3 mutants alter translational fidelity and promote rapid loss of the yeast killer virus.

Programmed -1 ribosomal frameshifting is utilized by a number of RNA viruses as a means of ensuring the correct ratio of viral structural to enzymatic proteins available for viral particle assembly. Altering frameshifting efficiencies upsets this ratio, interfering with virus propagation. We have previously demonstrated that compounds that alter the kinetics of the peptidyl-transfer reaction affect programmed -1 ribosomal frameshift efficiencies and interfere with viral propagation in yeast. Here, the use of a genetic approach lends further support to the hypothesis that alterations affecting the ribosome's peptidyltransferase activity lead to changes in frameshifting efficiency and virus loss. Mutations in the RPL3 gene, which encodes a ribosomal protein located at the peptidyltransferase center, promote approximately three- to fourfold increases in programmed -1 ribosomal frameshift efficiencies and loss of the M1 killer virus of yeast. The mak8-1 allele of RPL3 contains two adjacent missense mutations which are predicted to structurally alter the Mak8-1p. Furthermore, a second allele that encodes the N-terminal 100 amino acids of L3 (called L3Delta) exerts a trans-dominant effect on programmed -1 ribosomal frameshifting and killer virus maintenance. Taken together, these results support the hypothesis that alterations in the peptidyltransferase center affect programmed -1 ribosomal frameshifting.

Alleles↗
PubMed1975

Impact of expanded-duty assistants on cost and productivity in dental care delivery.

Data from an experimental dental program are used to develop a linear programming model of dental care delivery that the authors use to examine the economic implications of introducing expanded-duty dental assistants (EDDA's) in three types of dental practices. The authors examine the changes in productivity and profitability that result from hiring one or more EDDAs and conclude that a dentist in solo practice can more than double his net revenue by hiring one EDDA but will not increase his productivity further by hiring additional EDDAs. Two- and three-dentist groups also can increase revenue by hiring EDDAs, but, beyond a certain point, an inverse relationship exists between the number of auxiliaries hired and net revenue generated.

Cost-Benefit Analysis↗
PubMed2002

Health insurance for unemployed workers.

OBJECTIVE: In this article, we seek to inform the debate over providing assistance to workers who lose their jobs during the recession by assessing the potential impact of an economic downturn on health insurance coverage and reviewing available approaches to secure coverage for unemployed workers and their families. We also summarize recent research and analysis to examine the likely challenges and benefits of these approaches. DATA SOURCE: Data and analysis are primarily based on the Census Bureau's Current Population Survey, the Urban Institute's National Survey of America's Families, and Medicaid data from the Centers for Medicare and Medicaid Services. We also draw on recent surveys and analysis conducted by researchers in the health policy field. CONCLUSIONS: Maintaining health insurance coverage for unemployed workers is important to helping individuals and to stimulating our economy. While some families may be assisted by efforts to subsidize COBRA extension coverage, the potential reach of such an initiative is limited. Building on public programs such as Medicaid offers a targeted, efficient, and effective option but also presents financing challenges to federal and state governments.

Humans↗
PubMed1997

A computer program for the analysis of protein complex formation.

MOTIVATION: We needed an efficient way to explore the binding reactions leading to protein complexes of known composition and structure. RESULTS: A new program is described that allows the user to define a set of protein elements and to link these elements into an oligomeric 'ball-and-stick' assembly in a graphical interface. Once the structure of the oligomer has been defined, the program then employs a novel algorithm to deduce the binding reactions and intermediate complexes needed to make the oligomer from its starting protein components. The program also finds the equilibrium state of the system, using either default starting concentrations and Kd values or data supplied by the user.

Algorithms↗
PubMed2004

An evaluation of sexually transmitted infection case management in health facilities in 4 border provinces of Cambodia.

BACKGROUND: Cambodia has reported the highest prevalence of HIV in the general population in Asia. Sex work and high sexually transmitted infection (STI) prevalences are thought to be major contributory factors. GOAL: The goal of this study was to assess standards of STI care through a survey of public sector health facilities in 4 border provinces of Cambodia. METHODS: Healthcare facilities providing STI care were identified. Interviews were held with healthcare providers and STI patients and a manual check made of the STI register and standard medical history forms for female sex workers (SWs) registered with the 100% condom use program. Clinical management was assessed for SWs, women with vaginal discharge, and men with urethral discharge. Advice about condom use, partner notification, STI and HIV education, and availability of STI drugs were reviewed. RESULTS: Seven percent of all patients seeking health care at health centers (HCs) had STI-related problems. Coverage of sex workers was high in 3 provinces. Drug stock outs, particularly cefixime, occurred at all levels of assessment. In STI clinics, almost all (99-100%) cervicitis and urethritis cases were diagnosed and treated correctly. In HCs with integrated STI services, according to national guidelines, cervicitis was diagnosed in 65% of women with vaginal discharge of whom 47% were diagnosed correctly, and in these, 88% were treated correctly. Sixty-six percent of SWs seen at STI clinics were diagnosed with cervicitis and 54% at follow up. CONCLUSIONS: STI services should be expanded further to health centers not currently offering STI care. Overtreatment for cervicitis in both SWs at reattendance and low-risk women with vaginal discharge are continuing problems. The WHO/UNAIDS STI service indicator criteria had limited application for the assessment of SW services but were adapted for local needs. Attendance of SWs in designated STI clinics appears to be a useful indicator for the acceptability and efficiency of the current national STI program.

Ambulatory Care Facilities↗
PubMedDate not supplied

Utilization of nursing teams in the collection of blood.

The practice of nursing is group oriented. This was recognized in the past, but has only recently gained full acknowledgment by nursing managment. The concept of team assignment for the nursing staff was implemented in the blood program several years ago. The problems of the professional nurse in blood banking are not the same as in an acute or an extended care facility. Team assignments can improve both the delivery of care and the efficiency of the operation in the blood program. This paper describes many of the problems incurred under the system of conventional staffing and will show how these problems can be either eliminated or modified through the use of team assignment. Two centers experienced with permanent team assignments report these conclusions.

Blood Specimen Collection↗
PubMed2006

Research productivity and academic lineage in clinical psychology: who is training the faculty to do research?

This study examined the research productivity of graduates of American Psychological Association accredited, clinical psychology doctoral programs who currently hold faculty positions. Normative averages of aggregated publications over the 2000-2004 five-year period were computed. Rankings based on the mean number of publications produced by graduates of each training program and the number of graduates were significantly correlated with U.S. News and World Report rankings, although some important differences were noted. Programs that have produced a larger number of faculty members were also more highly ranked but there was increased variability for the number of publications produced by the larger numbers of graduates. Objective outcome analyses such as graduates' publications may be preferable to more subjective reputation rankings of programs. Particularly for scientist-practitioner and clinical-scientist training programs, outcome data such as graduates' publications is an important aspect of the programs' continued self-study.

Education↗
PubMed2001

Outcome of cardiac arrests in a Portuguese hospital--evaluation of a hospital cardiopulmonar resuscitation program at one year.

OBJECTIVE: Evaluation of a hospital-wide resuscitation program at one year. METHODS: All records of cardiac arrest calls were collected, logged in a database by the same operator, and analyzed. The cardiac arrest teams consist of a physician and a nurse with ALS (Advanced Life Support) training. Each team has a radio that is activated by a single emergency number. Only cardiac arrest calls were analyzed. RESULTS: Between March 1999 and March 2000 there were 173 emergency team calls. Of these, 120 were cardiac arrest calls (90 in-hospital and 30 from the emergency room--out-of-hospital cardiac arrests). Of the 90 in-hospital cardiac arrests, 61% were male, and median age was 73 years. In 90% of the calls, basic life support (BLS) was started before the arrival of the cardiac arrest team. The immediate cause was cardiac in 39% of the patients. Initial rhythm was ventricular fibrillation in 8%, asystole in 60% and other rhythms in 24% of the patients. Thirty percent presented return of spontaneous circulation (ROSC). There were no differences between those in whom BLS was started before the arrival of the cardiac arrest team and those in whom BLS had not been started. Ten patients (11%) were discharged from hospital. Of the 30 out-of-hospital cardiac arrests, 70% were male, and median age was 69 years. In 97% BLS was started before the arrival of the cardiac arrest team. The immediate cause was cardiac in 30% of patients. Initial rhythm was ventricular fibrillation in 10%, asystole in 73% and other rhythms in 17% of the patients. ROSC was achieved in 27% of the patients. Three patients (10%) were discharged from hospital. There were no differences either in ROSC or in survival to hospital discharge between in-hospital and out-of-hospital cardiac arrests. The state of health previous to cardiac arrest was significantly different between in- and out-of-hospital cardiac arrests: 3% versus 32% healthy, with no functional limitation. The authors conclude that: first, the current records do not enable all the desired goals of the "Utstein style" to be achieved and need to be reviewed; second, 90 to 97% of BLS previous to the arrival of the cardiac arrest team is a good indication of the efficiency of the hospital-wide program, which included training in BLS for all the hospital staff; third, the survival rate, although in accordance with much of the literature, could be improved.

Adolescent↗
PubMed1992

Medicare program; carrier jurisdiction for claims for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) and other issues involving suppliers, and criteria and standards for evaluating regional DMEPOS carriers--HCFA. Final rule with comment period.

This final rule Modifies regulations to provide that claims for durable medical equipment, prosthetics, orthotics and certain other items covered under part B of Medicare be processed by designated carriers. Specifies the jurisdictions each designated carrier will serve. Changes the method by which claims for these items are allocated among the carriers from "point of sale" to "beneficiary residence." Establishes certain minimum standards for suppliers for purposes of submitting the above claims. Incorporates in regulations certain supplier disclosure requirements imposed under section 4164 of the Omnibus Budget Reconciliation Act of 1990, as part of the process for issuing and renewing a supplier's billing number. Describes the criteria and standards to be used beginning October 1, 1993 for evaluating the performance of designated carriers processing claims for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) in the administration of the Medicare program. Section 1842(b)(2) of the Social Security Act requires us to publish criteria and standards against which we evaluate Medicare carriers for public comment in the Federal Register. We expect the above changes to lead to more efficient and economical administration of the Medicare program.

Durable Medical Equipment↗
PubMed1991

A University of California State-supported AIDS research award program--a unique state and university partnership in AIDS research.

This article describes the State-supported University of California AIDS research award program and its major accomplishments. It shows how a partnership between a University and a State resulted in the formation of a successful, efficient, and cost-effective AIDS research award program. This program provides funds for rapid testing of investigator-initiated meritorious research ideas, new drugs, and treatment modalities. Funds were also utilized to establish three AIDS Clinical Research Centers, which evolved into regional consortia that coordinate trials of new drugs and other modalities. This program succeeded in involving investigators whose efforts have led to excellent medical care, advanced technologies, and new drugs for treating AIDS and AIDS-related diseases. The University remains committed to continuing support of all areas of AIDS research, emphasizing drug and vaccine development, pediatric AIDS, and AIDS prevention studies in groups at high risk for HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Ribosomal pausing at a frameshifter RNA pseudoknot is sensitive to reading phase but shows little correlation with frameshift efficiency.

Here we investigated ribosomal pausing at sites of programmed -1 ribosomal frameshifting, using translational elongation and ribosome heelprint assays. The site of pausing at the frameshift signal of infectious bronchitis virus (IBV) was determined and was consistent with an RNA pseudoknot-induced pause that placed the ribosomal P- and A-sites over the slippery sequence. Similarly, pausing at the simian retrovirus 1 gag/pol signal, which contains a different kind of frameshifter pseudoknot, also placed the ribosome over the slippery sequence, supporting a role for pausing in frameshifting. However, a simple correlation between pausing and frameshifting was lacking. Firstly, a stem-loop structure closely related to the IBV pseudoknot, although unable to stimulate efficient frameshifting, paused ribosomes to a similar extent and at the same place on the mRNA as a parental pseudoknot. Secondly, an identical pausing pattern was induced by two pseudoknots differing only by a single loop 2 nucleotide yet with different functionalities in frameshifting. The final observation arose from an assessment of the impact of reading phase on pausing. Given that ribosomes advance in triplet fashion, we tested whether the reading frame in which ribosomes encounter an RNA structure (the reading phase) would influence pausing. We found that the reading phase did influence pausing but unexpectedly, the mRNA with the pseudoknot in the phase which gave the least pausing was found to promote frameshifting more efficiently than the other variants. Overall, these experiments support the view that pausing alone is insufficient to mediate frameshifting and additional events are required. The phase dependence of pausing may be indicative of an activity in the ribosome that requires an optimal contact with mRNA secondary structures for efficient unwinding.

Animals↗
PubMed1982

Concepts for automatic perimetry, as applied to the Scoperimeter, an experimental automatic perimeter.

The development of an experimental automatic perimeter, the Scoperimeter, is described. We use an oscilloscope as campimeter screen for the examination of the central 25 degrees of the visual field. The oscilloscope beam generates a homogeneous background luminance (0.1 cd/m2) and single stimulus static stimuli in any given position. The effective luminance-range of the stimuli is 3.0-3.5 log.unit. The visual field examination is controlled by a small computer system. Four examination programs written in Basic, are described. The screening programs using threshold related suprathreshold stimuli appear to be the most efficient compromise between speed and accuracy of the examination. The printout of these programs consists of a noninterpolated grey-scale presentation. Other programs perform static meridional perimetry or measure luminance threshold in 60 regularly distributed positions in the visual field. We have taken into consideration the factors that may influence the outcome of the examination: the presence of an instruction phase, the possibility to follow the progress of the examination and careful stimulus-timing. In a second paper we present clinical results we obtained using our instrument.

Humans↗
PubMed1992

[Multivariate study of auditory perception using multi-electrode cochlear implants].

The goal of this study was to determine the influence of auditory and cognitive factors in hearing or listening mechanisms with the Nucleus multielectrode cochlear implant. Accordingly, hearing sensitivity, psycho-acoustical masking functions and measures of temporal resolution were obtained from 14 adults with acquired deafness. In addition, six measures of open-set speech discrimination were introduced to represent a possible contribution of cognitive factors. Results indicated the contribution of both auditory and cognitive factors to speech understanding. Cognitive factors were most influential. Differences were also found in the relative importance of various cognitive factors, both before and after an intensive aural rehabilitation program. Initially, subjects relied more heavily on their ability to make efficient use of the linguistic redundancy of speech. At the end of the program, they paid more attention to speech acoustics, as a result of enhanced auditory spectral analysis and temporal resolution at about 2 kHz.

Adolescent↗
PubMedDate not supplied

What percentage of the Cuban HIV-AIDS epidemic is known?

The data for the Cuban HIV-AIDS epidemic from 1986 to 2000 were presented. With the purpose of evaluating the efficiency of the HIV detection system, two methods were used to estimate the size of the HIV-infected population, backcalculation and a dynamical model. From these models it can be estimated that in the worst scenario 75% of the HIV-infected persons are known and in the best case 87% of the total number of persons that have been infected with HIV have been detected by the National Program. These estimates can be taken as a measure of the efficiency of the detection program for HIV-infected persons.

Acquired Immunodeficiency Syndrome↗
PubMed2007

Complex trait genetics of refractive error.

Refractive errors (myopia, hyperopia, and astigmatism) are complex heterogeneous disorders of the human eye and are ideal for genetic investigation. Moderate to severe refractive errors can predispose individuals to poor visual development, various types of glaucoma, misshapen corneal surfaces, premature cataracts, and loss of retinal integrity, which can lead to detachment. Knowledge of genetic mechanisms involved in refractive error susceptibility may allow treatment to prevent progression or to further examine gene-environment interactions. Early genetic predisposition detection for developing severe refractive errors may be useful for efficient and cost-effective screening program design. This review explores the genetic mechanisms associated with nonsyndromic refractive error development known to date.

Animals↗