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PubMed2006

UVPAR: fast detection of functional shifts in duplicate genes.

BACKGROUND: The imprint of natural selection on gene sequences is often difficult to detect. A plethora of methods have been devised to detect genetic changes due to selective processes. However, many of those methods depend heavily on underlying assumptions regarding the mode of change of DNA sequences and often require sophisticated mathematical treatments that made them computationally slow. The development of fast and effective methods to detect modifications in the selective constraints of genes is therefore of great interest. RESULTS: We describe UVPAR, a program designed to quickly test for changes in the functional constraints of duplicate genes. Starting with alignments of the proteins encoded by couples of duplicate genes in two different species, UVPAR detects the regions in which modifications of the functional constraints in the paralogs occurred since both species diverged. Sequences can be analyzed with UVPAR in just a few minutes on a standard PC computer. To demonstrate the power of the program, we first show how the results obtained with UVPAR compare to those based on other approaches, using data for vertebrate Hox genes. We then describe a comprehensive study of the RBR family of ubiquitin ligases in which we have performed 529 analyses involving 14 duplicate genes in seven model species. A significant increase in the number of functional shifts was observed for the species Danio rerio and for the gene Ariadne-2. CONCLUSION: These results show that UVPAR can be used to generate sensitive analyses to detect changes in the selection constraints acting on paralogs. The high speed of the program allows its application to genome-scale analyses.

Algorithms↗
PubMedDate not supplied

A model for the integration of community-based health and social services.

This article describes a program designed by a case management organization and home health agency to improve the delivery of home care to the elderly. The results of a modified experimental-control study indicate that the cost of the services to the experimental group, who received comprehensive assessments, consolidated case management and joint monitoring, was less than the control group with an accompanying improvement in the quality of care. It is suggested that the program may be a practical model for local, community social service and health agencies seeking a way to increase continuity of care, improved quality, and reduce costs without difficult organizational and system changes.

Aged↗
PubMed2004

Reducing the incidence of pressure ulcers: implementation of a turn-team nursing program.

This study examined the effects a structured program designed to reduce pressure ulcers among patients in a midsized geriatric hospital. A select group of caregivers were organized into a "turn team that was responsible for preventive pressure ulcer care. Patient and staff data were collected during 6-month trial period. Subsequent analysis showed patient referrals to the staff enterostomal nurse and average length of stay, as well compensable musculoskeletal injuries among all staff declined. In addition, concerns the program might lead to an increased incidence of nosocomial infections were not substantiated.

Aged↗
PubMed2003

The reciprocal effects of program evaluation on service delivery for the SPNS adolescent HIV outreach and treatment programs.

PURPOSE: To describe the contexts within which the Special Projects of National Significance (SPNS) Adolescent HIV Outreach and Treatment programs were evaluated, the effects their evaluations had on their respective programs and, in turn, the effects the program delivery had on the evaluations. METHODS: The full range of process evaluation heuristics were used to analyze the bi-directional effects of conducting field-based, service delivery data collection. Although data collection efforts sometimes interfered with service delivery, and vice versa, several notable positive effects were disclosed. CONCLUSIONS: Specific guidance and recommendations were provided to program designers, behavioral researchers and institutional funding decision makers. Primary amongst them was a call for research evaluation designs that allow for maximum flexibility.

Adolescent↗
PubMed1990

Common illnesses and self-care.

Self-care has become a topic of widespread interest in recent years. However, few studies of the content and methods of self-care are available to inform health education program design. The present study identified common illnesses that were reported by 258 western university students and how those illnesses were typically cared for. Illness reporting differed significantly by gender, marital status, and perceived health status. Illness treatment differed only for perceived health status. Results suggest that treatment of an illness once self-diagnosed does not differ across groups but that labeling of illnesses does. The suggestion is made that educational programs may need to place greater emphasis on appropriate diagnosis of illness.

Adult↗
PubMedDate not supplied

Pre-school visually impaired children: visual stimulation and micro-computers.

A justification is offered for using micro-computers and specially-designed programs with severely visually impaired pre-school children. It is argued that this technology optimizes the visual environment for the child and provides immediate feedback about the correctness of his responses to the stimuli displayed on the screen. Some of the problems encountered in such use are described, with examples taken from sessions in which teachers are working with children as young as 2 years of age, using teaching/learning sequences designed to promote and exercise visual perception skills. Among the issues addressed are the nature of the language interactions between child and adult, the effects of altering the complexity of the tasks, and the possible value of formal task analysis as a means of enabling the teacher to pinpoint critical stages in the learning process.

Blindness↗
PubMed1999

Teaching study skills and test-taking strategies to elementary school students. The Testbusters Program.

A pilot program to reduce test anxiety and related social-evaluative concerns is presented. Testbusters is a program designed specifically for elementary and middle school children in grades 4 through 7 that teaches effective study habits, study skills, and test-taking strategies and includes a behavioral contract to ensure consistent study behavior. The assessment strategy includes self-report instruments, a behavioral assessment, and children's grade point averages. After a 6-month waiting period, eight children with moderate to severe test anxiety participated in the 11-week program. The results indicated that Testbusters decreased general levels of test anxiety and self-ratings of distress when taking a test. Overall grade point average improved significantly and grades in the majority of the subjects showed positive improvement. There was no change in overall self-esteem or judgments of cognitive competence. The results are discussed in terms of the use of a skills strategy to decrease anxiety and improve academic achievement.

Anxiety↗
PubMed1993

Teaching and social support: effects on knowledge, attitudes, and behaviors to prevent low back injuries in industry.

An educational program designed to reduce low back injuries was modeled after several well-known back schools and taught to postal workers in a randomized trial of about 4,000 workers. Physical therapists taught 3 hours of class sessions, including knowledge, skills, and individual work station assessment, to small groups of workers and supervisors, with reinforcement every 6 months afterward. At 2 1/2 years, a random sample of 209 workers was surveyed for program impact on intermediate outcomes. We observed increased knowledge among experimental unit workers, but no significant improvements in behaviors associated with back health or in proportion of workers with tired backs. Experimental unit workers who had received training by the time of the survey were less likely to report helping/reinforcement for healthy behaviors than controls or untrained experimental unit workers. The program might have led trained workers to perceive a lack of support and reinforcement for back safety among coworkers and supervisors by sensitizing them to what is possible and raising expectations. There appeared to be group social effects in the dissemination of knowledge and perhaps of helpful behaviors; however, it is apparent that worker social support for change in health behaviors is a complex phenomenon that cannot always be relied upon to enhance program goals.

Back↗
PubMed2005

Teaching elderly adults to use the Internet to access health care information: before-after study.

BACKGROUND: Much has been written about the Internet's potential to revolutionize health care delivery. As younger populations increasingly utilize Internet-based health care information, it will be essential to ensure that the elderly become adept at using this medium for health care purposes, especially those from minority, low income, and limited educational backgrounds. OBJECTIVE: This paper presents the results of a program designed to teach elderly adults to use the Internet to access health care information. The objective was to examine whether the training led to changes in participant's perceptions of their health, perceptions of their interactions with health care providers, health information-seeking behaviors, and self-care activities. METHODS: Participants attended a 5-week training course held in public libraries and senior community centers within the greater Pittsburgh and Allegheny County region. Classes within each seminar lasted 2 hours and consisted of lecture and hands-on training. Baseline surveys were administered prior to the course, 5-week follow-up surveys were administered immediately after the course, and final surveys were mailed 1 year later. Instruments included the Multidimensional Health Locus of Control (MHLC) Scale, which measures three domains of locus of control (internal, external, and chance); the Krantz Health Opinion Survey (HOS); and the Lau, Hartman, and Ware Health Value Survey. Two additional questionnaires included multiple choice and qualitative questions designed to measure participants' Internet utilization and levels of health care participation. The Health Participation Survey was administered with the baseline survey. The Internet Use Survey was administered at the 1-year mark and contained several items from the Health Participation Survey, which allowed comparison between baseline and 1-year responses. RESULTS: Of the60 elderly adults who began the training course, 42 (mean age 72) completed the entire 5-week training program and the 5-week follow-up questionnaire administered immediately after the program, and 27 completed the 1-year follow-up survey. Statistically significant differences were found between baseline and 5-week follow-up results for MHLC chance subscores in males (P = .02) and females (P = .05), as well as total HOS information seeking scores (P = .05). However, these statistically significant findings disappeared when all 60 original participants were included using a "last observation carried forward" imputation. No statistically significant changes were found between baseline and 5-week follow-up surveys for MHLC external (P = .44) and internal (P = .97) locus of control scores in both genders, or for the HOS behavioral involvement subscale (P = .65). CONCLUSIONS: We failed to show robust before-after effects for most of the outcomes measured. Elderly adults may be willing to use the Internet as a source for general health information; however, when making decisions about their health care, our participants seemed to adhere to a physician-centered model of care. Demographic and situational variables may play a large role in determining which seniors will use the Internet for making behavioral decisions about their health care and in which scenarios they will do so.

Aged↗
PubMed1997

Resource utilization and work or school loss reported by patients with diabetes: experience in diabetes training programs.

Diabetes exerts a major economic impact on healthcare in the United States both in terms of direct and indirect costs. Diabetes management and education programs designed to assist patients in achieving more optimal glycemic control represent a potential mechanism for reducing the morbidity and costs associated with diabetes. The relationship between HbA1c and patient hospitalizations and between HbA1c and days lost from work or school related to diabetes within the past year were evaluated. A cohort of 2359 patients with diabetes (188 type I, 2171 type II) referred to a comprehensive diabetes self-management training program was included in the analyses. Overall, 350 (14.8%) patients reported hospitalization, and 212 (9.0%) reported days lost from work or school. Patients with type I diabetes reported more hospitalizations (26.1% vs 13.9% and days lost (19.2% vs 8.1%) than type II patients. For the hospitalization outcome, the multivariate analyses indicated that younger age, the number of co-morbidities, and the duration of diabetes exerted a greater influence on the reported numbers of hospitalization than glycemic control. For the days lost outcome, the multivariate analyses indicated that there was a marginally significant association between patients with poor glycemic control and reported work or school loss related to diabetes (odds ratio = 1.5; 95% confidence interval, 1.0-2.2). These data suggest that interventions that improve glycemic control may decrease indirect costs related to diabetes.

Absenteeism↗
PubMed2004

Equivalence study of a dental anatomy computer-assisted learning program.

Tooth Morphology is a computer-assisted learning program designed to teach the anatomy of the adult dentition. The purpose of this study was to test whether Tooth Morphology could teach dental anatomy to first-year dental students as well as the traditional lecture. A randomized controlled trial was performed with forty-five first-year dental students. The students were randomly assigned to either the Tooth Morphology group (n=23), which used the computer-assisted learning program and did not attend lecture, or the lecture group (n=22), which attended the traditional lecture and did not use Tooth Morphology. The Tooth Morphology group had a final exam average of 90.0 (standard deviation=5.2), and the lecture group had a final exam average of 90.9 (sd=5.3). Analysis showed that the two groups' scores were statistically equivalent (p<0.05), with a priori equivalence bounds around the difference between the groups set at +/-5 points. It was concluded that Tooth Morphology taught the anatomy of the adult dentition as well as traditional lecture, as measured by exams. Based on the results of this study and student feedback, Tooth Morphology, in combination with interactive class meetings, has replaced the traditional dental anatomy lectures.

Adult↗
PubMed2001

Economic analysis of a child vaccination project among Asian Americans in Philadelphia, Pa.

OBJECTIVE: To ascertain the cost-effectiveness and the benefit-cost ratios of a community-based hepatitis B vaccination catch-up project for Asian American children conducted in Philadelphia, Pa, from October 1, 1994, to February 11, 1996. DESIGN: Program evaluation. SETTING: South and southwest districts of Philadelphia. PARTICIPANTS: A total of 4384 Asian American children. INTERVENTIONS: Staff in the community-based organizations (1) educated parents about the hepatitis B vaccination, (2) enrolled physicians in the Vaccines for Children program, and (3) visited homes of children due for a vaccine dose. Staff in the Philadelphia Department of Public Health developed a computerized database; sent reminder letters for children due for a vaccine dose; and offered vaccinations in public clinics, health fairs, and homes. MAIN OUTCOME MEASURES: The numbers of children having received 1, 2, or 3 doses of vaccine before and after the interventions; costs incurred by the Philadelphia Department of Public Health and the community-based organizations for design, education, and outreach activities; the cost of the vaccination; cost-effectiveness ratios for intermediate outcomes (ie, per child, per dose, per immunoequivalent patient, and per completed series); discounted cost per discounted year of life saved; and the benefit-cost ratio of the project. RESULTS: For the completed series of 3 doses, coverage increased by 12 percentage points at a total cost of $268 660 for design, education, outreach, and vaccination. Costs per child, per dose, and per completed series were $64, $119, and $537, respectively. The discounted cost per discounted year of life saved was $11 525, and 106 years of life were saved through this intervention. The benefit-cost ratio was 4.44:1. CONCLUSION: Although the increase in coverage was modest, the intervention proved cost-effective and cost-beneficial.

Adolescent↗
PubMed1999

Detection of apoptosis in chloroplasts and nuclei in different gravitational environments.

Plant cells either die by "accident" (traumatic cell death) or by "design" (programmed cell death; PCD). There is clear evidence that cell death during plant development and interactions with the environment involves PCD (in Gray and Johal, 1998). K. daigremontiana reproduces asexually by forming plantlets from leaf indentations which fall to soil and convert into adult plants. In nature, its entire plant body except leaf-plantlets senesces as consequence of floral differentiation or stressful environmental conditions. At unit gravity, PCD precedes plantlet detachment from the mother-leaf, leading to an abscission scar after plantlet fall. Earlier experiments have shown that leaf-plantlet formation and asexual reproduction increased with short duration hypergravity treatments and decreased in simulated hypergravity (Pedroso and Durzan, 1998). The present experiments were designed to determine if and what type of cell death occurs following gravitational changes, and the sequence of events leading to it. Our study shows that changes in gravitational environment cause a burst in nitric oxide, followed by a sequence of events that may ultimately led to programmed cell death by apoptosis.

Apoptosis↗
PubMed2006

The classification of violence risk.

The Classification of Violence Risk (COVR) is an interactive software program designed to estimate the risk that a person hospitalized for mental disorder will be violent to others. The software leads the evaluator through a chart review and a brief interview with the patient. At the end of this interview, the software generates a report that contains a statistically valid estimate of the patient's violence risk-ranging from a 1% to a 76% likelihood of violence-including the confidence interval for that estimate, and a list of the risk factors that the program took into account to produce the estimate. In this article, the development of the COVR software is described and several issues that arise in its administration are discussed.

Antisocial Personality Disorder↗
PubMed1999

JADE: computerization of a structured interview for childhood psychiatric diagnosis.

JADE is a new, computerized structured interview system to design, administer, and report results of the National Institute of Health's Diagnostic Interview Schedule for Children (NIMH-DISC). It has been developed under the auspices of the DISC Group at the Division of Child and Adolescent Psychiatry at Columbia University/New York State Psychiatric Institute. The development of JADE is based on extensive experience in the use of the DISC and with several previous computerized versions. It illustrates the importance to program design of consultation with those experienced in research and clinical application of the system and of the early adoption of a mature software development strategy.

Child↗
PubMed1981

Screening for the Tay-Sachs carrier: a compromise program.

A modified program designed to screen for the Tay-Sachs carrier is presented in which testing is limited to one or both partners, as needed, in an Ashkenazi Jewish (Jews of central and eastern Europe ancestry) mating when there is a definite commitment toward having a child, or in the early stages of the pregnancy. Testing of unmarried individuals is discouraged. The approach maximizes individualization of both the medical and laboratory aspects of the program and promotes a positive and beneficial relationship between physician and clinical chemist. There is little involvement of the lay population or clergy, and no special sources of funding are required. Whereas most mass screening programs for the Tay-Sachs carrier have attempted to educate large numbers of the lay public to bring pressure upon the medical community, we have reversed this approach and taken the much easier course of educating small numbers of physicians to better care for their patients. The program has been used successfully in a moderate-size city in which communication lines between laboratory and physician are easily established.

Communication↗
PubMed1996

Chronic obstructive pulmonary disease in horses in Louisiana.

OBJECTIVE: To evaluate chronic obstructive pulmonary disease of horses in Louisiana by assessing the signalment, history, environmental factors, clinical signs, and treatment of such horses. DESIGN: Epidemiologic mail survey. SAMPLE POPULATION: 83 of 240 veterinarians contacted by mail agreed to take part in the survey. Veterinarians contacted were listed as mixed-animal or equine practitioners in the 1991/1992 directory of the Louisiana Veterinary Medical Association or had submitted a specimen from a horse to the Louisiana Veterinary Medical Diagnostic Laboratory within the past 2 years. PROCEDURE: The survey contained 47 questions designed to elicit information from owners and veterinarians about horses reported to have chronic obstructive pulmonary disease (COPD). Questions were included to evaluate age, breed, sex, vaccination history, respiratory disease history, environment of primary activity, level of exercise, primary residence (pasture or stall), condition of pasture or barn, type and condition of feed, clinical signs, concurrent conditions, and treatment regimen prescribed. Information from the returned forms was analyzed by using a microcomputer program designed for epidemiologic data. RESULTS: Of the 83 veterinarians who agreed to participate, 31 returned 71 completed questionnaires for horses affected with COPD. Most affected horses were mature in age, kept on pasture, and had developed clinical signs during the summer months. The most consistent clinical signs were dry coughing, slight serous nasal discharge, labored expiratory effort, and flaring nostrils. CLINICAL IMPLICATIONS: Summer pasture-associated obstructive pulmonary disease appears to be precipitated by factors different than those associated with the traditionally diagnosed form of COPD and, thus, successful management measures may also vary.

Age Distribution↗
PubMed2000

Strategies for syphilis prevention: findings from surveys in a high-incidence area.

BACKGROUND: The persistence of syphilis in the United States suggests that a better understanding is needed of the potential for various public health approaches to prevent the spread of the disease. STUDY DESIGN: The authors conducted surveys of 92 persons with early syphilis, 56 uninfected sexual contacts, and 143 neighborhood controls in the Baton Rouge, Louisiana area. The surveys collected information regarding sexual behavior, access to and use of healthcare services, encounters at sites at which serologic screening for syphilis could be done, and exposure to interventions designed to prevent HIV infection. RESULTS: All groups reported high-risk sexual behavior. Cases and contacts were more likely than controls to report two or more sex partners in the previous year, but the three groups were similar in the percentage reporting five or more sex partners. Cases had poor access to health care and by some measures this access was less than that of controls. The potential screening site visited most frequently by cases was the public hospital emergency room (40%). Cases were less likely to have been exposed to programs designed to prevent HIV infection than uninfected contacts and controls combined (odds ratios, 0.51-0.66). CONCLUSIONS: Persons with syphilis were not unlike others in their neighborhoods, suggesting that syphilis is a sentinel event that indicates an entire neighborhood is at risk. Improvements in access to health care for sexually transmitted disease-related symptoms, screening in sites such as public hospital emergency rooms, and emphasizing sexual risk-reduction interventions may limit the spread of syphilis in these neighborhoods. To prevent syphilis in the long term, public health programs should also try to better understand and change other community-level socioeconomic factors that influence sexual behavior.

Adult↗