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PubMed2004

Ballistic reactions under different motor sets.

In preparation for performing task specific ballistic movements, subjects may choose among different possibilities for setting up their motor apparatus, ranging from quiet resting to different types of muscle activation. In the study presented here, we investigated whether differences in the motor set modify either the reaction time or the kinematic characteristics of the movement. Subjects wearing surface EMG recording electrodes in the wrist extensor (WE) and wrist flexor (WF) muscles were requested to react to the presentation of a visual stimulus by performing a ballistic wrist extension movement of an amplitude of about 50 degrees in the following experimental conditions: resting quietly, which was considered as the control condition (CC); isometric contraction (IC), in which subjects were required to activate WE and WF muscles isometrically; rapid oscillations (RO), in which subjects were requested to make a fast oscillatory wrist movement; and slow oscillations (SO), in which subjects were maintaining a slow oscillatory motion of the wrist. To constrain the movement to the wrist joint and limit the action of postural muscles, the subject's forearm and hand were attached to joined non-resistive metallic platforms, allowing for free non-frictional displacement. In the EMG recordings, we measured the size of the EMG bursts in agonist and antagonist muscles, and the inter-burst intervals. In movement recordings, we measured movement onset latency and the velocity profile. Movement onset was delayed in SO with respect to all other conditions. Conversely, peak velocity was larger in all test conditions in comparison to CC. There were no differences in the size of the first EMG burst of the agonist muscle, but significant changes occurred in the subsequent bursts recorded in the agonist and antagonist muscles. Our study indicates that the motor program used to execute a ballistic voluntary movement is influenced by the conditions of the motor system. The configuration of the motor set should be specifically considered in the search for improving the speed of the reaction and the kinematics of ballistic movements.

Action Potentials↗
PubMedDate not supplied

Quantitative analysis of motion control in long term microgravity.

In the frame of the 179-days EUROMIR '95 space mission, two in-flight experiments have foreseen quantitative three-dimensional human movement analysis in microgravity. For this aim, a space qualified opto-electronic motion analyser based on passive markers has been installed onboard the Russian Space Station MIR and 8 in flight sessions have been performed. Techhology and method for the collection of kinematics data are described, evaluating the accuracy in three-dimensional marker localisation. Results confirm the suitability of opto-electronic technology for quantitative human motion analysis on orbital modules and raise a set of "lessons learned", leading to the improvement of motion analyser performance with a contemporary swiftness of the on-board operations. Among the experimental program of T4, results of three voluntary posture perturbation protocols are described. The analysis suggests that a short term reinterpretation of proprioceptive information and re-calibration of sensorimotor mechanisms seem to end within the first weeks of flight, while a continuous long term adaptation process allows the refinement of motor performance, in the frame of never abandoned terrestrial strategies.

Adaptation, Physiological↗
PubMed1997

Establishing a successful HIV counseling and testing service. A blueprint for preventing pediatric HIV infections and translating research into clinical practice.

The findings of ACTG 076 have already resulted in local, state, and federal legislative initiatives targeted at pregnant and post-partum women and their newborns. This article advises clinicians and administrations on setting up successful voluntary prenatal HIV counseling and testing programs for early detection of HIV infection, and complying with the burgeoning array of legislative directives. Over the past several years their have been attempts to optimize and evaluate testing programs--perinatal ZDV counseling and administration of ZDV--and to link HIV-infected women with care in academic, community, and municipal hospitals. The suggestions are, therefore, broad enough to be applicable to a full array of clinical practices, from a private single provider office to a large hospital-based prenatal clinic. It is hoped that the models presented in this article can be replicated in diverse settings, and that readers can avoid the pitfalls and barriers sometimes encountered.

Counseling↗
PubMed2006

A statewide voluntary patient safety initiative: the Georgia experiene.

BACKGROUND: The Partnership for Health and Accountability (PHA), a voluntary quality improvement and patient safety program, has focused on comprehensive evaluation and feedback. Shared reporting of processes and outcomes is the vehicle for internal quality improvement. PHA provides access to quality and safety tools and benchmarking resources for a diverse group of hospitals, including rural and critical accessfacilities. PARTICIPATION AND OUTCOMES: Hospital participation in PHA-sponsored programs has increased each year, with all eligible hospitals participating in at least one PHA program. Participants in the Safe Medication Use initiative have seen reductions in targeted medication errors, and 97% of the hospitals have reported their performance on Joint Commission on Accreditation of Healthcare Organizations core measures. CASE STUDIES: Athens Regional Medical Center (315 beds) developed the Systematic Assessment of Flow and Error (SAFE) tool, which addresses patient information, clinical decisions, care processes, and patient flow, as a starting point for a wide range of quality improvement initiatives. Since 2004 Habersham County Medical Center, a small (53 beds), rural primary care hospital, has realized a decrease of more than 50% in the postoperative pneumonia rate and a significant decrease in surgical infection rates. DISCUSSION: PHA's challenge is to remain relevant, stable, and integrated and meet the needs of a diverse group of hospitals and yet remain flexible enough to evolve as systems and patient safety priorities change.

Benchmarking↗
PubMed2001

Australia's campaign to eradicate bovine tuberculosis: the battle for freedom and beyond.

In 1970, voluntary State-based TB control programs in Australia were replaced by a coordinated national campaign to eliminate both brucellosis and tuberculosis from the cattle population. The campaign was funded and managed under tripartite agreement by State/Territory and Commonwealth governments and Industry. The tuberculosis component of the campaign relied on test and slaughter with surveillance for the disease in abattoirs and trace-back to property of origin an essential component. Because of the moderate sensitivity of the skin test ( approximately 70%), testing was repeated at prescribed intervals over a number of years. In the more hostile environment of northern Australia, novel strategies were developed to maximize musters and remove 'at risk' animals. Australia is fortunate it did not have a feral host for M. bovis (apart from buffalo, which were included in the campaign) to complicate eradication. A national granuloma submission program was implemented in 1992 to increase the intensity of abattoir monitoring. Selective or total depopulation was used in some herds to achieve the requirements of the national Standard Definitions and Rules of the Campaign and achieve the status of 'TB Free Area' in December 1997. Monitoring for tuberculosis has continued under the 5-year Tuberculosis Freedom Assurance Program and measures to further reduce the risk of new cases have been implemented.

Abattoirs↗
PubMedDate not supplied

Health care in Nicaragua.

A two-week health study tour in Nicaragua in 1987 organized by the Health Network of the (British) Nicaragua Solidarity Campaign afforded the author of this report access to health service planning, first-hand observation of the immunization programme, and visits to centres for rehabilitation of the disabled, both from the war and civil causes. The efficacy of the low technology immunization and oral rehydration programmes is contrasted with the struggle to rehabilitate the war disabled with grossly inadequate resources.

Child↗
PubMed2000

Course and Severity of Substance Abuse in Women with Comorbid Eating Disorder.

The objective of this study is to ascertain whether the course and severity of Substance Abuse among female patients with comorbid Substance Related Disorder and Eating Disorder (SRD-ED) is similar to or different from the course and severity of SRD among female patients with Substance Related Disorder but no Eating Disorder (SRD). Subjects were voluntary patients, obtained in two addiction programs located within departments of psychiatry in two state university medical centers, and included 66 women with SRD-ED and 211 women with SRD. Data were collected on demography, course and severity of SRD, and associated biomedical conditions. SRD-ED patients were significantly younger and more apt to be single, more highly educated, living with family and friends, employed, and of higher socioeconomic status. SRD-ED and SRD patients were more similar than different on most indicators of course and severity, although several clinical differences prevailed. These clinical differences were primarily ascribed to age. In most respects, patients with comorbid SRD-ED manifest course and severity of SRD similar to patients with SRD. Demographic differences between the two groups can mostly be ascribed to the younger mean age of SRD-ED patients rather than to the comorbid ED. Some biomedical problems are related to the specific consequences of ED.

Journal Article↗
PubMed1995

HIV agencies: can they evaluate their own services?

This paper describes the development and implementation of self-evaluation methods and guidelines in non-statutory HIV agencies that have been funded by Lothian Health. Two researchers developed this work under the aegis of the Lothian Health Centre for HIV/AIDS and Drug Studies (CHADS). It was implemented in eight agencies providing a diverse range of services. The methodology used included seminars, interviews, and self-evaluation report booklets, which the agencies completed. This process was not designed to be a full evaluation on its own, but rather used in conjunction with independent health board evaluation and monitoring systems. It proved to be an effective system and is currently being used with drug services who have already received an independent evaluation.

Community Health Services↗
PubMed2005

A national program for injury prevention in children and adolescents: the injury free coalition for kids.

Injury is the leading cause of death and a major source of preventable disability in children. Mechanisms of injury are rooted in a complex web of social, economic, environmental, criminal, and behavioral factors that necessitate a multifaceted, systematic injury prevention approach. This article describes the injury burden and the way physicians, community coalitions, and a private foundation teamed to impact the problem first in an urban minority community and then through a national program. Through our injury prevention work in a resource-limited neighborhood, a national model evolved that provides a systematic framework through which education and other interventions are implemented. Interventions are aimed at changing the community and home environments physically (safe play areas and elimination of community and home hazards) and socially (education and supervised extracurricular activities with mentors). This program, based on physician-community partnerships and private foundation financial support, expanded to 40 sites in 37 cities, representing all 10 US trauma regions. Each site is a local adaptation of the Injury Free Coalition model also referred to as the ABC's of injury prevention: A, "analyze injury data through local injury surveillance"; B, "build a local coalition"; C, "communicate the problem and raise awareness that injuries are a preventable public health problem"; D, "develop interventions and injury prevention activities to create safer environments and activities for children"; and E, "evaluate the interventions with ongoing surveillance." It is feasible to develop a comprehensive injury prevention program of national scope using a voluntary coalition of trauma centers, private foundation financial and technical support, and a local injury prevention model with a well-established record of reducing and sustaining lower injury rates for inner-city children and adolescents.

Adolescent↗
PubMed1991

Assessing the first eight years of an optional five-year medical curriculum.

Experience with the initial eight years (1980-1987) of a voluntary five-year medical degree program at the Boston University School of Medicine is examined. The program, called the Alternative Curriculum, permits medical students to "decompress" the first year of their medical school curriculum. The program was designed to be a parallel curricular pathway and not a remedial program. Some students in academic difficulty, however, have been enrolled in this program. The students' records and their responses to a questionnaire form the basis for this report. The students who entered the Alternative Curriculum before the start of classes or who, upon entering, were in good academic standing generally did well academically and were uniformly pleased with the time that was available to pursue other interests. Several of these students were subsequently permitted to decompress other curricular years, with uniform success. Of the students for whom the Alternative Curriculum was used as a remedial program, nearly half had left or been dismissed from school at the time of this report.

Boston↗
PubMed2001

Population-based HIV testing and counseling in rural Uganda: participation and risk characteristics.

OBJECTIVES: To assess self-selection in a population-based voluntary HIV testing and counseling (VTC) program by comparing the HIV risk characteristics of users and nonusers of VTC in rural Uganda. DESIGN: A 1994 to 1995 community-randomized trial in the Rakai District of Uganda enrolled adults aged 15 to 59 years and ascertained their HIV status, sociodemographic characteristics, risk behaviors, and AIDS-associated symptoms. All subjects were offered confidential individual VTC at no cost. METHODS: We compared users and nonusers of VTC among 10,950 participants (4764 male and 6186 female) enrolled at baseline using multivariate logistic regression. RESULTS: Women were significantly less likely to receive VTC than men (31.5% vs. 34.8%, p <.001). In multivariate analysis, younger age, HIV-positive status, and having no sexual partners in the past 5 years (and, significant for women only, having 2 or more sexual partners) were associated with lower VTC participation for both men and women. Among women, higher VTC participation was associated with symptoms suggestive of AIDS and other illnesses and shopkeeper occupations. CONCLUSIONS: During the initial phase of a population-based free VTC program in rural Uganda, certain high-risk groups were underrepresented among VTC recipients. There is a need to target VTC to ensure participation by high-risk individuals most in need of services.

AIDS Serodiagnosis↗
PubMed2000

Patient-driven control of FES-supported standing up and sitting down: experimental results.

A patient-driven control strategy for standing-up and sitting-down was experimentally tested on two paraplegic patients by applying functional electrical stimulation (FES) to the quadriceps muscle. The strategy--also known as "patient-driven motion reinforcement" (PDMR)--was developed by computer simulations reported in a former study. It is based on an inverse dynamic model (IDM) that predicts the stimulation pattern required to maintain the movement as it is initiated by the patient's voluntary effort. For reasons of safety and weight relief, the movement was supported by a seesaw construction. After some practice the patients were able to influence the stimulator output and to control the movement by their voluntary effort. Consequently, no pre-programmed reference trajectory was required. As a positive side effect, upper body effort could be minimized compared to trials without FES. To achieve a satisfactory performance of the PDMR controller a careful parameter identification of the inverse dynamic model was fundamental.

Adult↗
PubMed2002

The New Zealand Blood Donors' Health Study: baseline findings of a large prospective cohort study of injury.

INTRODUCTION: Cohort studies have contributed important scientific knowledge regarding the determinants of chronic diseases. Despite the need for etiologic investigations, this design has been infrequently used in injury prevention research. OBJECTIVES: To describe the baseline findings of the New Zealand Blood Donors' Health Study, a large prospective study designed to investigate relationships between lifestyle, psychosocial factors, and serious injury due to road crashes, falls, self harm, assault, work, sport, and recreation. METHODS: Participants were recruited from fixed and mobile collection sites of a voluntary non-profit blood donor program. Baseline exposure data (for example risk taking behaviors, alcohol and marijuana use, sleep habits, and depression) were collected using a self administered questionnaire. Outcome data regarding serious injury will be collected prospectively through computerized record linkage of participants' unique identifiers to national morbidity and mortality databases. RESULTS: In total, 22 389 participants enrolled in the study (81% response rate). The diverse study population included 36% aged 16-24 years, 20% rural residents, and large variability in exposures of interest. For example, in the 12 months before recruitment, 21% had driven a motor vehicle when they considered themselves over the legal limit for alcohol, and 11% had been convicted of traffic violations (excluding parking infringements). Twelve per cent had seriously considered attempting suicide sometime in their life. CONCLUSIONS: This is the first, large scale cohort study investigating determinants of serious injury in New Zealand and among the largest worldwide. Preliminary findings from prospective analyses that can inform injury prevention policy are expected within five years.

Adolescent↗