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PubMed2003

Low-resolution molecular replacement using a six-dimensional search.

A parallel-aware program MPI_FSEARCH has been implemented to perform molecular replacement using an exhaustive six-dimensional search. In particular, the program can be used to deal with diffraction data at very low resolution (d > 10 A) that would normally not be appropriate for other molecular-replacement programs such as AMoRe and CNS. Although an envelope constructed from a PDB (Protein Data Bank) file was tested in the present study, the program can be used to perform low-resolution molecular replacement with an envelope derived from various sources such as electron microscopy or small-angle solution X-ray scattering.

6-Phytase↗
PubMed2002

Evaluation guidelines for adult and pediatric kidney transplant programs: the Missouri experience.

CONTEXT: Rigorous candidate evaluation is paramount for estimating risk and long-term success with transplantation. In addition, because of increasing waiting times, patients are seeking listing at multiple centers or transferring waiting time from one center to another. Variations in center evaluation criteria are becoming increasingly important to patients. OBJECTIVE: To describe the similarities and differences among the evaluation guidelines for adult and pediatric kidney transplant programs in Missouri. DESIGN: A descriptive design was used. SETTING AND PARTICIPANTS: Kidney transplant nurse coordinators from 7 adult and 4 pediatric kidney transplant programs from 10 centers in Missouri were invited to submit the kidney transplant candidate evaluation guidelines from their programs. RESULTS: Guidelines were submitted by nurse coordinators from all programs. Consults with the kidney transplant team members, including surgeon, nephrologist, social worker, and nurse coordinator, were included in all of the programs. For the adult programs, 67% (20/30) of the tests and laboratory values were agreed on by at least 70% of the program transplant team members. Similarly, for the pediatric programs, 62% (16/26) of the age-appropriate tests and laboratory values were agreed on by at least 75% of the program transplant team members. CONCLUSIONS: Within the Missouri programs, testing is consistent whether the center is large or small, adult or pediatric. Transplant teams should periodically review their kidney transplant recipient evaluation criteria for similarities to and differences from the current state-of-the-science and surrounding programs.

Adolescent↗
PubMed2000

Georgia's breastfeeding promotion program for low-income women.

OBJECTIVE: Beginning in 1990, Georgia's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) initiated 5 new strategies to promote breastfeeding among its pregnant and postpartum clients. These strategies were implemented in 1991, each to be provided as an addition to its standard program of counseling on breastfeeding and distributing appropriate literature: 1) enhanced breastfeeding education, 2) breast pump loans, 3) hospital-based programs, 4) peer counseling, and 5) community coalitions. The enhanced breastfeeding education strategy provides access to a hotline as well as periodic training of staff, and the breast pump loan provides free breast pumps to mothers who want to use them. The hospital-based strategy provides bedside support and counseling to women who have just given birth and includes staff training, as well as a hotline number for women to call after they leave the hospital. The peer-counseling strategy focuses on identifying former WIC participants who have successfully breastfed their infants; these women are recruited to provide support and encouragement to current WIC participants. Finally, the community coalitions approach is designed to identify existing community attitudes about breastfeeding, establish plans to address gaps in breastfeeding services, to develop resource guides on breastfeeding for the community, and to advocate at the community level to support breastfeeding women. The objective of our research was to evaluate the impact of breastfeeding promotion strategies on breastfeeding initiation among WIC participants in Georgia. METHODS: Using data from the Pregnancy Nutrition Surveillance System (PNSS) for 1992-1996, we examined breastfeeding initiation rate during this period and compared rates among 6 different intervention strategies. Also, we used data from the Pregnancy Risk Assessment Monitoring System (PRAMS) to assess breastfeeding initiation and duration among WIC enrollees. We conducted 13 focus groups to understand the experiences of program participants. Ten focus groups were conducted with women who were breastfeeding their infants, 3 each with women from the community coalitions, hospital-based programs, and standard education programs, and 1 with women from the breast pump loan program. Three focus groups were conducted with women who were feeding their infants formula. RESULTS: PNSS data show that breastfeeding initiation increased in the Georgia WIC program from 31.6% in 1992 to 39.5% in 1996. PRAMS data confirmed the increase in breastfeeding initiation from 33.6% (standard error [SE]: 2.2) in 1993 to 42.1% (SE: 2.4) in 1996 among WIC participants. Both datasets (PRAMS and PNSS) showed breastfeeding initiation to be well below the year 2000 goal of 75%. Overall, PRAMS data show a high breastfeeding initiation among non-WIC participants (range: 64.7% [SE: 2.2]) for 1994 to 70.1% (SE: 2.2) in 1996. The percent change between 1993 and 1996 was 8% for non-WIC participants, and it was 25% for the WIC participants among those responding to the PRAMS questionnaire. Data from PRAMS indicated no statistical change in the percentage of WIC enrollees who breastfed their infants for 8 weeks or more; this estimate was 18.3% (95% confidence interval (CI): 14.9-21.8) in 1993 and 19.4% (95% CI: 15.7-23.2) in 1996, well below the Healthy People 2000 objective of 50% at 6 months. According to PNSS data, the largest increases in breastfeeding initiation for 1992 to 1996 were among younger women (</=19 and 20-24 years old), those with no college (less than high school and high school only), unmarried, and black women (see Table 1). The smallest increases during this period were among older women (30+), those with more than a high school education, and women who were white, Hispanic, or from other ethnic or racial groups. The PRAMS data (1993-1996) generally display similar results, but the pattern by marital status demonstrated larger increases for married women than for unmarried women.

Breast Feeding↗
PubMed1985

Program planning in the Office of Technology Assessment's Health Program.

This paper describes the Congressional Office of Technology Assessment's Health Program and the role that its process of program planning has played in the selection of studies and the allocation of Program resources. It discusses the primary areas in which studies have been conducted--assessment methods, specific technologies, environmental health, information technologies, and financing/structural aspects of health care--and examines the changes in relative emphasis placed on the areas over time and the factors that lead to changed emphasis. Internal factors--e.g., judgments of whether a topic is of national importance, fiscal and staff resources available, and whether the issue is appropriate for OTA--and thus program planning have played their strongest role in the areas of assessment methods and of specific technologies. Activities in the financing/structural areas and some types of studies in the environmental health areas are being driven more by external factors--e.g., expressed needs of Congress, availability of data, and developments in science and technology.

Government Agencies↗
PubMed1999

Assessment and regulation of health care technology. The Dutch experience.

OBJECTIVES: To evaluate the characteristics, methods, and results of the Dutch Investigative Medicine Program ("ontwikkelingsgeneeskunde") in policy and health care. METHODS: Project database analyses of the initial 9 years of the program; description of characteristics, methods, and effects of the program. RESULTS: By the end of 1997, 53 projects had been completed, including implementation in health care policy. In 20 of 53 cases the program worked as an instrument to prevent the introduction of ineffective, inefficient, or even harmful medical interventions. In most other cases the program assisted with proper placement or appropriate application of new technologies. Apart from new or emerging technologies, already existing technologies are evaluated. CONCLUSION: The Dutch Investigative Medicine Program ("ontwikkelingsgeneeskunde") of the Sickness Funds Council is an effective collaboration of health care providers, medical science, health economics, and a regulatory body in empirical technology assessment. It is also an example not only of a substantial contribution of technology assessment to decision making in practice and policy but also of a means of regulation of health care by the very activity of technology assessment itself. It appears that the program has evolved into an instrument to rationalize health care and health care policy, although some further possible improvements are identified.

Decision Making, Organizational↗
PubMed2000

Managing the demand for health services by adopting patient-centered programs.

Recently, the trend to managing the demand of health care services has become more prevalent. Standalone types of demand management programs are patient-centered and support appropriate health care decision making by the consumer. The author examines these types of programs including their benefits and risks.

Cost Savings↗
PubMed1995

New study on child survival.

Family planning can save lives of children and benefit the health of mothers, according to a study published recently by the UN Population Division. Entitled "The Health Rationale of Family Planning: Timing of Births and Child Survival," the study finds that survival of children can be improved through delaying child-bearing at least until the mother reaches age 18 and possibly age 20, and more especially through achieving birth intervals of at least two years. Those survival benefits are quite considerable, it states, and are likely to be complemented by wider health benefits for the child. For the health of the mother, the benefits lie in avoidance of the repeated risk of pregnancy and birth. The study encompasses over 280,000 births and nearly 35,000 deaths before age five in 25 developing countries. It recommends that family planning programs should highlight the importance of the appropriate timing of births and supply methods to achieve better spacing of births. Health programs should also encourage breast-feeding, not just to improve the survival and nutritional chances of the current child, but also to delay the next pregnancy and thus increase the survival chances of both the existing and the next child.

Age Factors↗
PubMed1985

The rationale for the use of preoperative chemotherapy.

A considerable amount of experimental and clinical data support the idea that there is a strong relationship between tumor mass and potential curability by chemotherapy. Malignancies for which there could be no realistic expectation of cure when treated at the advanced stage, may be quite sensitive to cure if the treatment can be initiated at a time when the tumor burden is very small. The somatic mutation model of drug resistance and cancer chemotherapeutic effect predicts a steep relationship between tumor burden and curability. One clinical implication of such a relationship is that the time period over which a significant proportion of individual cases would move from a position of curability to incurability may be substantially shorter than what one would intuitively expect. This argues for the earliest feasible utilization of appropriate chemotherapy as part of adjuvant treatment programs. This introduces a component of urgency into establishing a correct diagnosis and commencing appropriate anticancer drug treatment. Such measures may have the potential for increasing cure rates in a variety of human solid tumors for which adjuvant chemotherapy is deemed an appropriate technique. With the demonstration of the relative safety of such approaches then many of the ethical concerns about the early use of chemotherapy can be assuaged. One of the attractions of the method of preoperative chemotherapy is that it offers the possibility of improving cure rates in a variety of common human malignancies without developing new classes of antineoplastic drug or entirely novel treatment approaches. The prompt institution of chemotherapy during the perioperative period may have greater impact on the natural history of the disease than much more aggressive and complex treatment utilized in the later stages.

Breast Neoplasms↗
PubMed2004

Pharmacodynamic comparisons of antimicrobials against nosocomial isolates of escherichia coli, klebsiella pneumoniae, acinetobacter baumannii and pseudomonas aeruginosa from the MYSTIC surveillance program: the OPTAMA Program, South America 2002.

The OPTAMA (Optimizing Pharmacodynamic Target Attainment using the MYSTIC [Meropenem Yearly Susceptibility Test Information Collection] Antibiogram) Program provides insight into the appropriate antibiotic options for empiric therapy for common nosocomial pathogens. In this report, South America is represented by Brazil, Colombia, Peru, and Venezuela. A 5000-subject Monte Carlo Simulation estimated pharmacodynamic target attainment for meropenem, imipenem, ceftazidime, cefepime, piperacillin/tazobactam, and ciprofloxacin against Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Pharmacokinetic parameter variability was derived from existing healthy volunteer data, and minimum inhibitory concentration (MIC) data came from the 2002 MYSTIC program. Piperacillin/tazobactam and ciprofloxacin displayed the lowest target attainment against all bacterial species (14% to 24% for A. baumannii, 26% to 37% for P. aeruginosa, and 48% to 66% for the Enterobacteriaceae). Overall, the carbapenems had the highest probabilities of attainment against the Enterobacteriaceae (98% to 100%) and A. baumannii (73% to 74%), whereas cefepime obtained the greatest target attainment against P. aeruginosa (65%). Because no single regimen had high target attainment against A. baumannii and P. aeruginosa, the use of combination therapy to treat these pathogens in South America may be justified. Because of the lack of agreement with percent susceptibility for certain antimicrobial regimens, the use of pharmacodynamic target attainment may be a more accurate predictor of microbiologic success.

Acinetobacter baumannii↗
PubMed2006

Cutoff and target values for intra-abdominal fat area for prevention of metabolic disorders in pre- and post-menopausal obese women before and after weight reduction.

BACKGROUND: The Japan Society for the Study of Obesity originally proposed a cutoff value of >100 cm(2) for the intra-abdominal fat area (IFA) as a definition for "visceral fat obesity" in Japanese adults. There are no studies on the cutoff or target values after weight reduction in pre- and post-menopausal women. METHODS AND RESULTS: In the present study 149 pre-menopausal obese women (PreM, 43.3 years, 27.3 kg/m(2)) and 58 post-menopausal women (PostM, 53.9 years, 27.7 kg/m(2)) participated in a 14-week weight reduction program. The IFA was measured by computed tomography. The program induced significant reductions in body weight (8.6 kg in PreM and 7.8 kg in PostM). The IFA decreased significantly from 80.4 +/- 41.3 to 50.7 +/- 23.8 (PreM) and from 115.4 +/- 38.0 to 75.7 +/- 30.5 (PostM). CONCLUSIONS: The receiver-operating characteristic curve analyses revealed that the appropriate cutoff values were 80 cm(2) (PreM) and 110 cm(2) (PostM) before the program, and after the program the appropriate target values were determined as 60 and 70 cm(2), respectively.

Abdomen↗
PubMed2002

Defining and evaluating professionalism: a core competency for graduate emergency medicine education.

Professionalism, long a consideration for physicians and their patients, is coming to the forefront as an essential element of graduate medical education as one of the six new core competency requirements of the Accreditation Council for Graduate Medical Education (ACGME). Professionalism is also integral to the widely endorsed Model of the Clinical Practice of Emergency Medicine (Model). Program directors have now been charged with implementing the new core competencies in training programs and to assess the acquisition of these competencies in their trainees. To assist emergency medicine (EM) program directors in this endeavor, the Council of Emergency Medicine Residency Directors (CORD-EM) held a consensus conference in March 2002. A focused Consensus Group addressed the specific core competency of professionalism during the course of this conference, and the results are highlighted in this article. The definition and curricular requirements relating to professionalism are highlighted, specific techniques for evaluating this core competency in EM are reviewed, and recommendations are provided regarding the most appropriate assessment method for EM programs.

Behavior↗
PubMed1991

Tobacco-use reduction among high-risk youth: recommendations of a National Cancer Institute Expert Advisory Panel.

The National Cancer Institute's efforts to prevent tobacco-related cancers have resulted in numerous activities to reduce smoking prevalence throughout the United States. Two decades of research activity has provided much of the information needed for interventions through channels such as mass media, physician/dentist training, self-help strategies, and school-based prevention programs. However, in the area of adolescent tobacco-use reduction, it has been consistently observed that youth who have the highest tobacco-use rates are among those least likely to be reached through school-based or other programs. Thus, these youth, often labeled "high-risk," are seen as a cornerstone for tobacco use prevention efforts. Although they pose a particularly difficult access problem, many valuable recommendations for strategies to identify and reach this group were made by a recent NCI-convened Expert Advisory Panel on the Prevention and Cessation of Tobacco Use by High-Risk Youth. The Panel considered this issue from three perspectives--methods of identifying these youth, strategies for reaching them with appropriate tobacco-use prevention/cessation programs, and identification of research needs. Their recommendations and conclusions are summarized in this article. Support for research addressing the prevention and cessation of tobacco use among high-risk youth is currently being considered by the NCI.

Adolescent↗
PubMed1989

Multidimensional assessment of the elderly via a microcomputer: the SENOTS program and battery.

We compared the psychometric adequacy of a multidimensional self-report battery for use with cognitively able, elderly adults under conditions of microcomputer and interviewer administration. The SENOTS battery contains scales of Happiness/Depression, Financial Hardship, Physical Symptoms, Activity Limitation, and Activity Propensity. The SENOTS microcomputer program contains sequential phases intended to (a) select out respondents incapable of interacting adequately with the microcomputer, (b) train respondents to make appropriate keyboard responses. (c) administer the program, and (d) store and process the responses. The SENOTS battery was administered to 80 community residents and 80 institution residents by either a microcomputer or an interviewer. Results indicated a comparable psychometric adequacy to the SENOTS battery under both administration conditions. Internal consistencies were all at acceptable levels, and the scales differentiated the community residents from the institution residents.

Activities of Daily Living↗
PubMed1976

The effects of token reinforcement on the behavior of delinquents in cottage settings.

A token economy designed to modify the behavior of 125 adolescent males committed to a state correctional institution was implemented in the boys' cottages, focusing on social behavior (peer interaction), rule following, and task completion. The program was sequentially introduced in a multiple-baseline design in three independent cottages; a fourth group served as a comparison cottage. Appropriate behavior increased when the token program was introduced in each cottage. Data were collected for 14 months. Thus, the long-term effects of initial behavior change were assessed.

Adolescent↗
PubMed1989

The genetic risk screening, education, and referral program: a model program for training of health professionals.

This report describes a statewide program which trains family-planning personnel to provide genetic risk screening, to educate clients about potential genetic risks, and to make appropriate referrals to genetics centers. The program is unique in that training and service delivery are all done within the structure and agencies of the family-planning councils of Pennsylvania. Through the collaboration of the Pennsylvania Department of Health, the family-planning councils, and trainers from clinical genetics centers, a uniform and comprehensive program for training and service delivery has evolved. This program now provides genetic risk screening for nearly 100,000 women/year, many of whom are from groups typically underserved by genetics services.

Curriculum↗
PubMed2003

[The new residency program in neurological surgery in Spain].

A new Residency Program in Neurological Surgery has been recently elaborated by the "Comisión Nacional de Neurocirugía" following the requirement of the National Council of Specialities. This new Program, which will replace the one proposed in 1992, has been designed in a similar way as those applied in countries providing the best neurosurgical training. Changes included deal with the definition of the speciality, and the introduction of new rotations,a resident Log Book, a Tutor with a well defined profil and commitments, a structured planning of academic and clinical objectives, a rotation or training in research, and a planning for continuous evaluation of the progress of the resident. It is likely that an appropriate application of the new Program in Spanish neurosurgical units with accreditation for training will result in formation of highly competent neurosurgeons. However, there are new challenges for improving neurosurgical training and the development of our speciality in Spain, as those related with new legislation regulating resident working hours, or some political decisions changing the mechanisms for controlling the number of resident positions per year.

Curriculum↗
PubMed2006

Self-presentation of beryllium by BAL CD4+ T cells: T cell-T cell interactions and their potential role in chronic beryllium disease.

Chronic beryllium disease (CBD) is characterized pathologically by granulomatous inflammation in the lung, composed of a large core of epithelioid cells surrounded by a dense shell of CD4+ T cells. Using beryllium-specific CD4+ T cell lines derived from the bronchoalveolar lavage (BAL) fluid of CBD patients, we show that purified CD4+ T cells produced significant amounts of IFN-gamma and TNF-alpha upon exposure to beryllium in the absence of antigen-presenting cells (APC). However, unlike BAL T cells stimulated by beryllium in the presence of APC, self-presentation by BAL T cells did not induce detectable IL-2 production, and in its absence these activated T cells die from programmed cell death. Resting BAL CD4+ T cells constitutively express high levels of HLA-DP, lymphocyte function-associated antigen 1 (LFA-1) and ICAM-3. When stimulated with beryllium/APC, the adhesion molecule ICAM-1 was up-regulated, as well as several costimulation molecules including CD28, OX-40 (CD134), 4-1-BB (CD137) and B7-1 (CD80). Notably, CD28 was not up-regulated during self-presentation by BAL T cells, and these cells do not express OX-40L, suggesting that lack of appropriate costimulation was responsible for programmed cell death observed upon beryllium self-presentation. Restricting anti-MHC class II mAb completely eliminated beryllium-induced T cell proliferation during self-presentation and significantly reduced IFN-gamma and TNF-alpha production. Our data demonstrate for the first time that self-presentation by BAL T cells in response to beryllium can occur ex vivo, in the absence of professional APC, with a specific dependence on T cell-expressed MHC class II molecules and exogenous IL-2 for survival.

Antigen Presentation↗
PubMed2005

The impact of culturally relevant violence prevention models on school-age youth.

The Family and Community Violence Prevention (FCVP) Program was established in 1994 to address the escalation of youth violence among ethnic minorities. This federally funded program adapted the public health model and organized Family Life Centers throughout the country to serve youth who were considered to be at risk for violence and other abusive behaviors. The purpose of this three-year study, 1999-2002, was to determine the effectiveness of the FCVP Program's six-component curriculum in reducing violence among participants. Results from posttest scores of 2,315 youth showed girls 12 and over to be most at risk for deviant behaviors; the program was most effective with boys under age 12. Academic performance and bonding to school were protective factors whereas exposure to violence was a risk factor for all four ethnic groups studied--African Americans, Hispanics, Native Americans, and Native Hawaiians. EDITORS' STRATEGIC IMPLICATIONS: Cultural anthropologists, public health specialists, and school officials should know that prevention programs can be designed to reflect the unique, culturally appropriate norms of specific ethnic minority groups, even as these programs address shared risk factors. The authors discuss the promising strategy of enhancing academic performance and school bonding to serve as protective factors against school violence, but they also describe age, gender, and cultural differences that must be addressed in future research.

Adolescent↗