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Interaction between visual and vestibular signals for the control of rapid eye movements.

To investigate interactions between voluntary and reflexive eye movements, five subjects were asked to make pro- or anti-saccades to various oblique locations cued by a head-fixed flash while being rotated sinusoidally in yaw (0.17 Hz; 73 degrees /s peak velocity) in complete darkness. Eye movements were recorded with the coil technique. In the pro-saccade task, targeting responses showed clear compensation for the intervening nystagmus, but there was a marked increase in horizontal scatter. Most quick phases directed into the hemifield opposite to the flash (away trials) were suppressed from ~100 ms onward. By contrast, quick phases directed into the hemifield of the flash (toward trials) continued virtually unabated until visually triggered saccades began to appear. From 80 ms onward, these vestibularly triggered movements showed signs of metrical modification by the visual signal. In the anti-saccade experiments, suppression of quick phases away from the flash was just as strong as in the pro-saccade experiments, and error rates in these trials were almost as low as in stationary control conditions. Suppression of quick phases directed toward the flash was a new phenomenon that emerged only in anti-saccade experiments. Since this inhibition had a late onset and was only partial, error rates in anti-saccade toward trials were very high. At short latencies, both components of most rapid eye movements were wrongly directed toward the flash. This was followed by a stage with frequent incongruent responses in which unsuppressed quick phases provoked an incorrect horizontal movement, whereas the vertical component showed a correct anti-saccade response. At still longer latencies, most responses were correct in both components. The visual modification of short-latency responses in both tasks showed that rapid eye movements could not simply be classified as either voluntary or reflexive, but suggested that signals underlying each class could merge into a compromise response. That vestibular rotation during the anti-saccade task may cause a wrongly directed horizontal component resembling a quick phase, combined with a vertical component expressing a correct anti-saccade signal, reveals a remarkable independence at the component level. These observations suggest that voluntary and involuntary movements can be programmed in parallel. This behavior is explained most parsimoniously by assuming that the two signals converge at a component-coding stage of the system, rather than at a vectorial coding stage.

Adult↗

Effects of prevalence and testing by enzyme-linked immunosorbent assay and fecal culture on the risk of introduction of Mycobacterium avium subsp. paratuberculosis-infected cows into dairy herds.

A stochastic simulation model was developed to assess the risk of introduction of Mycobacterium avium subsp. paratuberculosis infection into a dairy herd through purchase of female replacement cattle. The effects of infection prevalence in the source herd(s), number of females purchased, and testing by enzyme-linked immunosorbent assay (ELISA) alone or ELISA and fecal culture as risk mitigation strategies were evaluated. Decisions about negative test results were made on a lot and individual basis. A hypothetical dairy herd, free from M. a. paratuberculosis, which replaced 1 lot (10, 30, or 100) of cows per year, was considered. Probability distributions were specified for the sensitivities and specificities of ELISA and fecal culture, the proportion of infected herds and within-herd prevalence for randomly selected replacement source herds (high prevalence) and herds in level 2 (medium prevalence) and level 3 (low prevalence) of the Voluntary Johne's Disease Herd Status Program (VJDHSP). Simulation results predicted that 1-56% of the lots had at least 1 M. a. paratuberculosis-infected cow. Assuming that ELISA sensitivity was 25%, simulation results showed on a lot basis that between 0.4% and 18% and between 0.1% and 9% were predicted to have at least 1 infected cow not detected by ELISA and by a combination of ELISA and fecal culture, respectively. On an individual cow basis, between 0.1% and 8.3% of ELISA-negative cattle in ELISA-positive lots were estimated to be infected. In both the lot and individual analyses, the probability of nondetection increased with larger lot sizes and greater prevalence. Sensitivity analysis indicated that the effect of a lower ELISA sensitivity (10%) was a variable decrease in mean detection probabilities for all combinations of prevalence and lot size. The benefit of testing introduced cattle with ELISA alone or in combination with fecal culture was found to be minimal if cows were purchased from known, low-prevalence (level 3) herds. The value of testing by ELISA alone or in combination with fecal culture was greatest in high-prevalence herds for all lot sizes. Testing of random-source cattle, bought as herd replacements, can partially mitigate the risk of introduction of M. a. paratuberculosis but not as well as by using low-prevalence source herds (level-3 VJDHSP), with or without testing.

Animals↗

A community health education approach to occupant protection.

The goal of enhancing motor vehicle occupant protection is vital to the public's health. Controversies about passive versus active protection and voluntary versus mandatory measures continue. A program which employed a combination of positive reinforcements (incentives) and wide-scale community education succeeded in raising the community seat belt usage rate from 24 to 41% in 6 months. This rate was sustained at 36% at six-month follow-up. This article reviews the major features of the "Seat Belts Pay Off" campaign and its evaluation and considers both theoretical and pragmatic issues pertinent to replicating the program in other community settings.

Adult↗

A comparative cost analysis of alternative models of adult day care.

An analysis of the component costs of adult day care (ADC) programs in the Commonwealth of Pennsylvania indicates widely varying experiences in terms of fiscal and contractual administrative arrangements. Medical model ADC, program-funded services, and those agencies performing their own client assessments reported higher client per diems than the social model, slot-funded, and non-ADC assessed programs. For-profits displayed cost characteristics similar to their not-for-profit counterparts. Medical and slot-funded programs more frequently turned to multiple sources for budget supplementation. All program types tended to depend on voluntary client contribution methods as compared to means-tested approaches when determining fee-for-service.

Aged↗

Current and future trends in AIDS in New York City.

Over the past five years, the proportion of AIDS cases among gay and bisexual men in New York City has fallen as the proportion of AIDS cases has risen among IV drug abusers, the major channel of HIV infection to children and heterosexuals in New York City. By 1991, there will be over 40,000 cumulative AIDS cases in New York City, with close to 30,000 deaths. Controlling the spread of HIV infection among drug addicts, children, and heterosexuals requires education, outreach, and exploration of strategies such as increasing the legal availability of sterile needles and syringes. For at least the next several years, massive programs of public health education and voluntary, confidential risk-reduction counseling and HIV antibody testing will remain our critical weapons for reducing the spread of HIV infection among people engaged in high-risk behavior as well as among the general public.

Acquired Immunodeficiency Syndrome↗

Relations between nutrition and cognition in rural Guatemala.

The nutritional status of three and four year old children, as measured by height and head circumference, is related to cognitive performance in four rural Guatemalan villages. The relationships persist when social factors are taken into account. Families in two of the villages participate in a voluntary, high protein-calorie supplementation program. In the other two villages, the families receive a vitamin and mineral supplement with one-third of the calories. Although the longitudinal study still is ongoing there is some evidence that the children who receive the higher calorie supplement (or whose mothers received it during pregnancy and lactation) are most likely to score high in cognitive performance. The results support other animal and human studies that report an association between nutrition and cognitive development. The findings, while not diminishing social environmental explantions of differences in cognitive function, suggest the worth of nutrition intervention programs in rural areas of lesser-developed countries.

Child Development↗

The association of personality characteristics with parenting problems among alcoholic couples.

This retrospective cross-sectional study explored the associations of personality characteristics with parenting problems among 25 couples, one or both members of which were identified as alcoholics by virtue of their voluntary past completion of a residential program for alcoholics. Most of them (90%) scored lower, indicating their more problematic parental attitudes and behaviors, on all four scales of the Adult-Adolescent Parenting Inventory (AAPI: inappropriate parental expectations of children, lack empathy for children's needs, value physical punishment, and parent-child role reversal) than average "normal" nonalcoholic, nonabusive adults. Such parenting problems were found to be very highly associated with clients' personality characteristics. For example, schizoid, schizotypal, histrionic, and passive aggressive characteristics (DSM-III-R-based) along with a few other personal characteristics of the couples, accounted for nearly all (90.2%, R2 = .902) of their propensity to reverse roles with their children. Findings also suggested that the identified parenting problems among alcoholic couples are amenable to programmatic intervention: the longer couples had participated in aftercare programs offered by the treatment facility the more appropriate and empathetic was their parenting.

Adolescent↗

[Memisa: from medical missionary action into a medical relief organization].

In the past seventy years Memisa Medicus Mundi has grown into an organization accounting for about half the annual number of Dutch health care workers in third world countries. On top of this, it gives financial and material support to many development programmes in Africa, Asia and Latin America. Of all aid, 82% is given to so-called structural programmes and 18% to disaster relief. Physicians who return to the Dutch health care system as general practitioners after a period abroad are capable of efficient practice management.

Africa↗

[Memisa and home care for AIDS patients in Zambia].

Health care in Zambia has since long been receiving support from non-governmental organizations (NGOs) like Memisa. Church organizations bear responsibility for a considerable part of the national health services. During the last 15 years, growing attention has been given to improvement of basic services in the villages and to recruitment and organization of groups in the community active in the field of health care. The combat against AIDS is a major focus. Many NGOs give health education on HIV and AIDS, are coaching HIV-positive individuals and are trying to organize support for AIDS patients and their relatives and relief for women and children after the death of husband or father. The community home care projects established in the urban areas of Copperbelt province in Zambia provide a decent terminal phase for AIDS patients and assist the surviving families in maintaining a certain socioeconomic level of existence.

Acquired Immunodeficiency Syndrome↗

A survey of selected issues involving pharmacy technician training in Canada.

A non-random, snowball sampling technique was used to survey eleven Canadian pharmacy technician training programs and thirteen pharmacy regulatory and voluntary bodies on issues surrounding pharmacy technicians. A 100% response rate was achieved in the questionnaires which targeted issues such as nomenclature, certification, accreditation, and education of pharmacy technicians. Survey results indicate that while many provincial pharmacy regulatory boards have addressed issues such as the nomenclature and workplace role of pharmacy technicians, there is a lack of consensus and discussion in the areas of certification, accreditation, and responsibility for continuing education.

Accreditation↗

Successful collaboration: the Cincinnati initiative.

Private-sector initiatives, like the one launched in Cincinnati, have significantly improved the management of health care programs. The initiatives were made through voluntary hospital and physician practice changes without new contract restrictions, price controls, legislative mandates, and utilization management.

Cost Savings↗