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PubMedDate not supplied

Professional practice of pediatric nurse practitioners: implications for education and training of PNPs.

INTRODUCTION: The purpose of this study was to describe the characteristics of employment, the characteristics of children served, and the role functions of recent graduates of pediatric nurse practitioner (PNP) programs and to compare these characteristics across programs. METHOD: A 60-item multiple-choice survey tool was sent to graduates from 1996-1998 of 6 universities across the United States. RESULTS: A total of 137 surveys were received for a return rate of 52%. Less than half of the respondents (44%) indicated that they were employed in a primary care practice. Seventy percent indicated they "often" or "sometimes" provided care to children with acute/critical conditions, and 77% reported caring for children with chronic conditions. Role functions of case management, staff development, consultation, administration, and implementation of research were performed "often" or "sometimes" by more than 50% of respondents. Findings were fairly consistent in 5 out of 6 programs surveyed. DISCUSSION: Graduates of PNP programs are increasingly called on to provide care to children with complex health care needs in non-primary care settings. Role functions beyond the traditional areas required for pediatric primary care are now common practice. Educational programs should address these dynamic changes by assessing the adequacy of their curricula and clinical residencies in preparing graduates.

Case Management↗
PubMed2002

Informing policy and service development at the interfaces between acute and aged care.

This paper argues that policies to address the interfaces between acute care and aged care should view older people as members of the wider Australian population entitled to a range of health services under Medicare rather than focusing only on supposed "bed blockers". In seeking to explain the current level of policy interest in this area, three areas are canvassed: pressures on acute hospital care, particularly those attributed to population ageing; shrinking provision of residential aged care; and the proliferation of post acute services. If policy development is to maintain a wider rather than narrower perspective, attention needs to be given to improving collection and analysis of critical data that are currently unavailable, to developing system-wide funding arrangements for post acute care, and to reassessing what constitutes appropriate hospital activity for younger and older age groups alike.

Acute Disease↗
PubMed1990

Practice and the dynamics of handwriting performance: evidence for a shift of motor programming load.

Sixteen adult subjects were served in an experiment in which the writing of six unfamiliar graphemes was practiced. To investigate the learning process, we analyzed the absolute and relative changes of movement time of the first three consecutive segments as a function of practice. The results showed that movement time of all three segments decreased. This decrease was significantly less in the first segment that it was in the second and third segment, however. We interpret these effects of practice, from an information-processing viewpoint, as follows: (a) Initially separate response segments become integrated in more comprehensive response chunks, and (b) the preparation of later segments of the grapheme is realized more and more during the real-time execution of the initial segment. The results further revealed that these learning effects were more pronounced in graphemes composed of familiar segments than in graphemes that contained unfamiliar segments. Finally, it turned out that similarity between initial and final segments hindered the writing speed of the first segment; the effect of similarity was independent of the above-mentioned effects of practice. The latter effect is interpreted as confirming evidence for the view that the preparation of later segments of a grapheme is reflected by changes of movement time of the first segments of a grapheme.

Journal Article↗
PubMed2001

Home- and community-based long-term care: lessons from Denmark.

PURPOSE: Denmark is cited as a model in the development of home- and community-based systems for the frail elderly population. We examined the results of this natural experiment and considered implications for U.S. policy. DESIGN AND METHODS: We used international comparative policy analysis, including site visits and semistructured interviews with Danish leadership in conjunction with a review of published literature, reports, and administrative data from Denmark and the United States. RESULTS: After 12 years of implementing integrated systems for home- and community-based services in 275 municipalities, growth in Danish long-term care expenditures has leveled off; expenditures appear to be decreasing for the over-80 population and have dropped as a percentage of the gross domestic product. Access to and quality of long-term care services appear to remain generally satisfactory. During this period, comparable expenditures in the United States have increased, and deficits in access and quality persist. IMPLICATIONS: These findings should be of interest to state and federal policy makers considering strategies to reduce the rate of growth in Medicaid and Medicare expenditures for elders and to expand home- and community-based services.

Aged↗
PubMed1994

Molecular modeling of the interaction of polyproline-based peptides with the Abl-SH3 domain: rational modification of the interaction.

A molecular model of the interaction of polyproline-rich peptides with the Abl-SH3 domain is proposed, based on docking calculations with the DOCK program coupled with molecular dynamics simulations. Two distinct binding modes of the peptide to the same aromatic-rich region (Tyr10, Phe12, Trp39, Trp50, Tyr55) of the domain were obtained. It is proposed that these two models could represent different binding modes of proline-rich peptides to Src homology region 3 domains. Several peptide mutants were designed to determine whether the two orientations were possible. Analysis of the Kd values and fluorescence emission of these peptides indicate that one of the orientations is more plausible and that residues at position 4 of the peptide interact with the RT loop, being important in modulating the peptide affinity for the Abl-SH3 domain.

Amino Acid Sequence↗
PubMed1976

10. Issues in designing a national program of long-term care benefits.

This paper discusses a major policy area in long-term care--the design of a comprehensive national program of long-term care benefits--for which a broad base of information is needed. In the continuum of social welfare, a program for long-term care is veiwed as being in the middle ground between health care and income maintenance. Significant issues include the extent of coverage in terms of population groups and types of services, and the relative emphasis given to institutional care, to organized services enabling persons to remain in their homes, and to support of informal care from relatives and friends. Other considerations are methods of controlling costs and utilization, sharing of responsibility between federal and state governments, and establishement and enforcing of standards for providers of services. Two proposals introduced in the 93rd Congress illustrate current approaches to comprehensive long-term care benefits.

Costs and Cost Analysis↗
PubMed2005

Whole-body biodistribution, radiation dosimetry estimates for the PET norepinephrine transporter probe (S,S)-[18F]FMeNER-D2 in non-human primates.

BACKGROUND: (S,S)-[F]FMeNER-D2 is a recently developed norepinephrine transporter ligand which is a potentially useful radiotracer for mapping the brain and heart norepinephrine transporter in vivo using positron emission tomography. In this work, we quantified the biodistribution over time and radiation exposure to multiple organs with (S,S)-[F]FMeNER-D2. METHODS: Whole-body images were acquired for 21 time points in two cynomolgus monkeys for approximately 270 min after injection of radioligand. Compressed 3-D to 2-D planar images were used to identify organs with the highest radiation exposure at each time point. Estimates of the absorbed dose of radiation were calculated using the MIRDOSE 3.1 software program performed with the dynamic bladder and ICRP 30 gastrointestinal tract models. RESULTS: In planar images, peak values of the percent injected dose (%ID) at a time after radioligand injection were calculated for the lungs (26.76% ID at 1.42 min), kidneys (13.55% ID at 2.18 min), whole brain (5.65% ID at 4.48 min), liver (7.20% ID at 2 min), red bone marrow (5.02% ID at 2.06 min), heart (2.36% ID at 1.42 min) and urinary bladder (23% ID at 250 min). Assuming a urine voiding interval of 2.4 h, the four organs with highest exposures in microGy . MBq ( mrad . mCi) were kidneys 126 (468), heart wall 108 (399), lungs 88.4 (327) and urinary bladder 114 (422). The effective doses were estimated with and without urine voiding at a range of 123 (33) and to 131 (35.5) microGy . MBq ( mrad . mCi). CONCLUSION: The estimated radiation burden of (S,S)-[F]FMeNER-D2 is comparable to that of other F radioligands.

Animals↗
PubMed2003

Imperfect vaccination: some epidemiological and evolutionary consequences.

An aim of some vaccination programmes is to reduce the prevalence of an infectious disease and ultimately to eradicate it. We show that eradication success depends on the type of vaccine as well as on the vaccination coverage. Vaccines that reduce the parasite within-host growth rate select for higher parasite virulence and this evolution may both increase the prevalence of the disease and prevent disease eradication. By contrast, vaccines that reduce the probability of infection select against virulence and may lead more easily to eradication. In some cases, epidemiological feedback on parasite evolution yields an evolutionary bistable situation where, for intermediate vaccination coverage, parasites can evolve towards either high or low virulence, depending on the initial conditions. These results have practical implications for the design and use of imperfect vaccines in public- and animal-health programmes.

Animals↗
PubMed2005

Economic evaluation for conservation of farm animal genetic resources.

The decline in biodiversity of farm animal genetic resources (AnGR) has come to the forefront of concern in the discussion of animal conservation and breeding programmes. To improve decision-making regarding conservation and breeding programmes, a number of evaluation techniques of farm AnGR are available. This paper presents an overview of the different values associated to AnGR and of the techniques for their measurement being employed in the economic literature. Those include linear programming and farm simulation models, dynamic models estimating the value of research and development and econometric models estimating the demand for breed characteristics. While farm programming and simulation models are fairly well developed, they do have large data requirements. Alternatively, contingent valuation methods are available, in particular when the goal is to capture non-market values embedded in breeds.

Animal Husbandry↗
PubMed2005

Geriatrics in Brazil: a big country with big opportunities.

Brazil has approximately 180 million inhabitants, of whom 15.2 million are aged 60 and older and 1.9 million are aged 80 and older. By 2025, the Brazilian elderly population is expected to grow to more than 32 million. Brazil has many problems related to its geographic and population size. Great distances between major cities, marked cultural and racial heterogeneity between the various geographic regions, high poverty levels, and decreasing family size all combine to put pressure on the medical and social services that can be made available to the elder population. Less than 500 Brazilian physicians are certified as geriatricians, translating into one geriatrician for every 37,000 elderly Brazilians. Beside 15 geriatric medicine residencies a larger number of fellowship programs exist, and these programs are in high demand, with more than 20 candidates per position, indicating new opportunities for growth in elder care. In addition, geriatric initiatives such as the annual elder vaccination program and the elder statute, recently approved by the Brazilian Congress, indicate that geriatric care in Brazil is entering a new era of growth and development. Although the challenges remain great, there are opportunities for Brazilian geriatrics and gerontology.

Aged↗
PubMed1976

Effect of strength training on enzyme activities and fibre characteristics in human skeletal muscle.

Progressive strength training was performed 3 times a week for 8 weeks by 14 male students (19-31 yrs.). The training program consisted mainly of dynamic exercises for the leg extensors with maximal or close to maximal loads. The training caused significant improvements in dynamic and isometric strength. One repetition maximum in squats increased with 67%, Sargent jump with 22%, and maximal voluntary isometric contraction (MVC) with 13%, respectively. Body weight and leg muscle circumferences remained unchanged after training, whereas total body potassium, lean body mass and calculated total muscle mass increased, suggesting a change in body composition with training. Muscle biopsies were obtained from vastus lateralis for fibre analyses and determination of enzyme activities. There were no changes in muscle fibre composition or fibre area with training. The activities of Mg2+ stimulated ATPase, creatine phosphokinase and phosphofructokinase remained unchanged, whereas myokinase activity was increased after training from (1.41 to 1.52 moles x 10(-4) x g-1 x min-1, p less than 0.05). After training significant correlations (p less than 0.01) were demonstrated between Mg2+ stimulated ATPase activity and % fast twitch fibres (% FT) (r = 0.67), as well as between myokinase activity and % FT (r = 0.86).

Adenosine Triphosphatases↗
PubMed2002

Analysis of B cell memory formation using DNA microarrays.

DNA microarray analysis of B cell subsets has identified comprehensive programs of gene expression that distinguish B cells at discrete stages of differentiation. The next task is to identify key genetic signals within these complex programs that regulate the dynamic cellular events during B cell activation in vivo. After stimulation with antigen, naïve B cells proliferate and differentiate, and then produce antibodies. Crucial qualitative differences in antibody responses are observed depending on whether or not B cells receive T cell help during activation. Proteins, lipopolysaccharides, and polysaccharides stimulate T-dependent (TD), T-independent type 1 (TI-1), and type 2 (TI-2) antibody responses, respectively. Only TD responses generate somatically mutated antibody-forming (plasma) cells and memory B cells, which produce high affinity anamnestic responses to subsequent antigen challenge. Somatic mutation of immunoglobulin genes occurs during B cell proliferation in germinal centres (GC), which are typical in TD responses but rare in TI responses. However, we have described a model, which is exceptional because numerous large GC form in response to a model TI-2 antigen, (4-hydoxy-3-nitrophenyl) acetyl (NP)-Ficoll. Significantly, these GC undergo involution before memory B cells are generated. This model provides an opportunity to investigate the genetic signals that drive memory cell formation, and we have compared global gene expression in TI and TD GC to identify a relatively small number of genes that are differentially expressed between the two prototypic B cell responses. This model demonstrates how genome-scale technology can be adapted to investigate specific aspects of B cell biology.

Animals↗
PubMed2003

A role of the basal ganglia in movement: the effect of precues on discrete bi-directional movements in Parkinson's disease.

The effect of a precue on improving movement initiation (i.e., reaction time; RT) is well understood, whereas its influence on movement execution (i.e., movement time; MT) has rarely been examined. The current study investigated the influence of a directional precue (i.e., left vs. right) on the RT and MT of simple and discrete bi-directional movements in a large sample of Parkinson's disease patients and healthy control participants. Both patients and controls were tested twice, with testing sessions separated by 2 hours. Patients were tested first following an overnight levodopa withdrawal and again after they had taken their medication. Both patients and controls demonstrated a significant RT improvement when information was provided in advance. MT in both healthy participants and medicated patients was, however, slower with the provision of advance information, while unmedicated patients showed no significant MT effects. These results suggest that while the basal ganglia may not be involved in motor program selection, they may dynamically modulate movement execution.

Adult↗