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A Macintosh computer program for designing DNA sequences that code for specific peptides and proteins.

A computer program (PINCERS) is described for use in the design of synthetic genes and mixed-probe DNA sequences. A protein sequence is reverse translated with generation of synonymous codons at each position producing a degenerate sequence. In order to locate potential restriction enzyme sites, the degenerate sequence is searched with a library of restriction enzymes for sites that utilize any combination of synonymous codons. These sites are indicated in a map so that they may be incorporated into the synthetic gene sequence. The program allows the user to select the appropriate codon usage table for the organism of interest and then to set a threshold usage frequency below which codons are not generated. PINCERS may also be used to assist in planning the synthesis of mixed-probe DNA sequences for cross-hybridization experiments. It can identify regions of specified length with the protein sequence that have the least overall degeneracy, thereby minimizing the number of probes to be synthesized and, therefore, maximizing the concentration of a given probe sequence.

DNA↗

Factors affecting participation in external degree completion programs.

Although many dental hygienists have considered pursuing a baccalaureate degree, many barriers intervene to prevent accomplishment of this goal. The external degree is one option that could be available to overcome some of the barriers to accessibility. An external program is one that makes education accessible to students in nontraditional ways. A characteristic of these programs is that students can usually pursue academic credit toward a degree without being physically present on the degree-granting campus for the majority of the program. This paper reports the results of a 1988 survey of certificate and associate degree dental hygienists' interest in an external baccalaureate degree completion program. A questionnaire was mailed to 213 certificate and associate degree dental hygienists in Tennessee who had expressed an interest in degree completion. Two hundred six questionnaires were returned for a response rate of 96.7%. In order to determine the potential success of such programs, the following factors were explored: the motivations or reasons for participating; program design factors that might encourage or deter participation; degree of employer support; and individual characteristics relevant to participation, such as personal commitment and demographic information. Geographic location, flexibility in scheduling, and accessibility to course work were the program design factors most important to the likely participants. Likely participants indicated that they wanted to return to complete their baccalaureate degrees for personal satisfaction, for the status of the degree, and to increase their knowledge and skill in dental hygiene. They indicated that they did not want to change the focus of their careers. The area of study rated as most important was advanced clinical dental hygiene. The likely participants were found to resemble other nontraditional students. They averaged 34 years of age, were married with children living at home, and were able to study on a part-time basis only. The analysis of the data obtained from the questionnaire led to the conclusion that external program design factors would be essential for most certificate and associate degree dental hygienists to participate in a baccalaureate degree completion program.

Adult↗

The effects of an advanced practice nurse-directed heart failure program.

A study was conducted to determine if an inpatient heart failure program directed by an advanced practice nurse (APN) affects the following patient outcomes: length of hospital stay, mortality, readmission rates, and adherence to the recommended clinical regimen. Evaluating APN-directed heart failure programs may assist hospitals and clinics to determine whether such programs should be replaced, modified, continued, or replicated. For those facilities that are considering beginning a heart failure program, the data provided in this study may help establish the necessity of developing such a program or provide ideas for program design. The APN has an integral role in program design and can assist in achieving positive patient outcomes.

Aged↗

SEQPWR and SEQOPR: computer programs for design of maximum information trials based on group sequential logrank tests.

The maximum information trial paradigm for clinical trials with failure time data was recognized and has been investigated. With the maximum information trial paradigm, a study is concluded when a prespecified maximum number of events of interest, thus maximum information, has been accrued if there was no early stopping due to treatment difference or lack thereof. We present two interactive FORTRAN programs for use in designing maximum information trials based on group sequential logrank tests. The program SEQPWR computes the attainable power of group sequential logrank tests given the combinations of the accrual and follow-up durations. The program SEQOPR allows the users to investigate the operating characteristics of the maximum information trial given the information fractions of interim analyses. A clinical trial from the Eastern Cooperative Oncology Group is provided to illustrate the usage and features of the programs.

Algorithms↗

Primer design for large scale sequencing.

We have developed PRIDE, a primer design program that automatically designs primers in single contigs or whole sequencing projects to extend the already known sequence and to double strand single-stranded regions. The program is fully integrated into the Staden package (GAP4) and accessible with a graphical user interface. PRIDE uses a fuzzy logic-based system to calculate primer qualities. The computational performance of PRIDE is enhanced by using suffix trees to store the huge amount of data being produced. A test set of 110 sequencing primers and 11 PCR primer pairs has been designed on genomic templates, cDNAs and sequences containing repetitive elements to analyze PRIDE's success rate. The high performance of PRIDE, combined with its minimal requirement of user interaction and its fast algorithm, make this program useful for the large scale design of primers, especially in large sequencing projects.

Algorithms↗

Dance for health: improving fitness in African American and Hispanic adolescents.

Cardiovascular disease begins early in life but might be prevented or delayed by primary prevention programs designed for children and adolescents. Regular physical activity is an important part of primary prevention programs, and school physical education programs have potential for the promotion of regular physical activity. Cardiovascular disease is the major cause of death among Hispanics and African Americans in the United States. Low levels of fitness and increased body mass index are common in African American and Hispanic adolescents. Increased physical activity and the adoption of healthy eating habits would increase fitness and reduce body mass index among these adolescents. The purpose of the study was to undertake a small-scale controlled trial to determine if Dance for Health, an intervention program designed to provide an enjoyable aerobic program for African American and Hispanic adolescents, has a significant effect on improving aerobic capacity, helping students maintain or decrease weight, and on improving attitudes toward physical activity and physical fitness. In the first year of the program (1990-91), approximately 110 boys and girls ages 10-13 years participated in an aerobic dance pilot program three times per week for 12 weeks. Dance for Health was revised and continued in the 1992-93 school year with seventh grade students and an added culturally sensitive health curriculum. Forty-three students were randomized to Dance for Health and 38 to usual physical activity. Those in the intervention class received a health education curriculum twice a week and a dance oriented physical education class three times a week. The usual physical activity consisted mostly of playground activities. Students in the intervention had a significantly greater lowering in body mass index and resting heart rate than students in regular physical activity.

Adolescent↗

ICWU cancer control education and evaluation program: research design and needs assessment.

The International Chemical Workers Union is implementing a 3-year nationwide field experiment in cancer prevention education. The educational program includes three stages: generalized cancer control education, education tailored to each local union, and an interactive monitoring system designed to provide ongoing communication and reinforcement for desired cancer control behaviors among local unions and their members. These alternative educational approaches will be systematically evaluated using a randomized factorial study design involving more than 120 local unions. The need for such a program is demonstrated by the results of a needs assessment survey of 690 union members. Respondents expressed strong concern regarding possible carcinogen exposures at the work site, combined with generally low ratings of co-worker knowledge of and adherence to appropriate cancer control behaviors. Engineering controls and personal protective equipment were reported to be inadequate in many work sites.

Attitude to Health↗

The role of designated driver programs in the prevention of alcohol-impaired driving: a critical reassessment.

We review the "designated driver" concept and the current debate over its role in preventing alcohol-impaired driving. In our view, the focus on this strategy by broadcasters, the alcohol industry, and various public service groups has deflected attention from other alcohol-related problems that account for the vast majority of deaths and injuries associated with alcohol use. This focus has also distracted many public health advocates and policymakers from the bigger and more important jobs of increasing public awareness of the social, environmental, and economic factors that influence alcohol consumption and promoting debate on legislation and other public policy solutions to alcohol-impaired driving. As part of a comprehensive strategy, we strongly encourage a renewed focus on "sobriety checkpoints," strict enforcement of laws against alcohol sales to minors, alcohol advertising reform, increased excise taxes, and other public policy initiatives supported by the Surgeon General. These measures will curb underage and heavy alcohol consumption and will create a legal and social environment in which individuals are motivated to avoid impaired driving through several alternative strategies, including but not limited to the use of designated drivers.

Accidents, Traffic↗

A model for the improvement of medical faculty lecturing.

The development of a program designed to improve the teaching effectiveness of faculty members of a new Introductory Psychopathology course at the University of Washington School of Medicine is described. Two consultants from the Office of Research in Medical Education worked closely with the faculty in designing the evaluation program during the preparation of the course. The literature on lecture effectiveness is reviewed, as are existing instructional evaluation instruments. The integration of this information and the needs of the involved faculty produced a lecture observation schedule designed to facilitate the observation of a lecture and the immediate feedback which followed each of the 15 lectures evaluated. The process of using this instrument to assist the faculty in self-improvement is discussed. While the specific evaluation method described may not be appropriate for all situations, it may serve as a model for the development of similar programs in other settings.

Evaluation Studies as Topic↗

The Georgia State Telemedicine Program: initiation, design, and plans.

This paper describes the genesis, implementation, and operation of the Georgia Statewide Telemedicine Program, a full-service system that provides a comprehensive range of clinical and consultative services to all residents of the state through a hub-and-spoke network. When completed, it will consist of several tertiary-care centers and a set of secondary hubs at medical centers throughout the state. Each hub will, in turn, serve several remote sites. The system enables connectivity throughout the network, and the overall coordination, implementation, and oversight is provided by the Center for Telemedicine at the Medical College of Georgia. The evolution of the system is described, together with lessons learned from the experience.

Academic Medical Centers↗

Regen: program for designing gene assembly.

One of the main problems in constructing synthetic genes is the incorrect hybridisation between the oligonucleotides. The problem is resolved if the sequence uniquely defines the position of the oligonucleotide in the assembled gene. This can be accomplished through the wise partition of dsDNA sequence in the fragments. We describe a program for use in designing such gene assembly. For a given DNA sequence and the approximate location of oligonucleotide boundary it generates all sets of protruding ends that share the smallest homology.

Algorithms↗

Occupational therapy in the Department of Veterans Affairs: focus on health care of the elderly veteran.

The Department of Veteran Affairs (VA) operates the largest integrated health care system in the world (VA, 1989), with designated departments and programs designed to meet the long-term care needs of the aging veteran. Occupational therapy is an important intervention to maximize the quality of life of older persons. Because of the increasing number of aging veterans and the national shortage of occupational therapists, the VA has been devising programs to recruit and retain occupational therapists in VA medical centers. The combination of long-term care programs and the VA's commitment to ongoing research, education, and occupational therapy services points to a promising outlook for care of our aging veterans.

Aged↗

A walking education program for patients with osteoarthritis of the knee: theory and intervention strategies.

Walking is an ideal physical activity for patients with osteoarthritis because it can help to improve functional status without exacerbating pain or necessitating an increase in the use of medication. Although patient education programs designed to encourage walking have become increasingly important in the management of this condition, there is no single synthesis or other published source of theory and intervention strategies to guide the practitioner in the development of such programs. This paper describes a hospital-based patient education program designed to enhance the functional capacity of who have osteoarthritis of the knee by encouraging the adoption and maintenance of walking. The paper describes the goals, objectives, process, and impact of the program; the principal theoretical model utilized in the design of the program; and how concepts and intervention strategies from the literatures on patient compliance and patient education, exercise compliance, behavioral psychology, and relapse prevention have been operationalized and integrated in a walking program that we have evaluated for safety and efficacy.

Adult↗

Process surveillance: an epidemiologic challenge for all health care organizations.

Historically, qualitative and quantitative monitoring of patient care practices related to infection control may have been only marginally correlated with findings of nosocomial infection surveillance. More recent developments in health care have included an emphasis on "outcome management," as well as an enthusiasm for applying industrial process improvement methods. Health care organizations may choose to incorporate process surveillance as an adjunct to or a surrogate for outcome measurement. An essential characteristic of a well-designed process surveillance program is a direct relationship with clearly articulated and logically prioritized outcome objectives. To optimize value and efficacy, the program design should be consistent with the organizational strategic plan and sensitive to the needs of members of the health care team to which the data would be reported. Process data must be objectively and consistently measurable, feasible to collect, and, ideally, expressed as rates or ratios to support valid comparative analyses. Infection control professionals should approach development of process surveillance systems with a logical and organized construct.

Documentation↗

Inhibitors of the enzyme purine nucleoside phosphorylase as potential therapy for psoriasis.

Purine nucleoside phosphorylase (PNP) is one of the enzymes comprising the purine salvage pathway , and is responsible for the catalysis of the reversible phosphorolytic cleavage of purine ribonucleosides and 2'-deoxyribonucleosides. The pivotal role of PNP in T-cell proliferation has been demonstrated in patients with inherited PNP deficiency, where T-cell levels may be 1-3% of normal. This observation helped establish the critical role of PNP in T-cells and provided a rationale for developing inhibitors of PNP. Inhibitors of PNP may be useful for treating a variety of T-cell related autoimmune diseases including psoriasis, rheumatoid arthritis and Crohn s disease and T-cell cancers. In this manuscript, the x-ray crystal structure of the PNP enzyme is described. Results of a structure-based drug design program aimed at designing small-molecule inhibitors of PNP are also described. Of the many classes of compounds synthesized, studied and reviewed, only one, the 3-pyridinylmethyl-9-deazaguanine (BCX-34, 39) analog has been used in clinical trials. Both topical and oral formulations of BCX-34 were studied in psoriatic patients and the results of these clinical trials are described.

Drug Design↗

Mobile screening mammography for the corporate customer.

While the concept of mobile imaging services is not new, mobile screening mammography has recently gained a great deal of attention, and several mobile breast screening programs are in operation throughout the United States. This article describes the development of a mobile breast screening program designed to attract corporations' employees as its primary source of participants. The design of the program, corporate concerns and operational issues are discussed as well as the findings of its first year of operation.

Data Collection↗

Intervention approaches to conduct disorders in young children.

The scope of the problem in regard to childhood aggression or conduct disorders is large and far exceeds the resources for dealing with them. Moreover, such children are at high risk for developing serious adolescent and adult psychological problems. Nurse practitioners are placed in strategic positions to be able to screen for, identify and treat early signs of conduct disorders in young children. This review describes assessment procedures and the essential components of a parent training program designed to help families reduce childhood aggression. By intervening with families early, nurse practitioners may be able to design effective preventive programs and improve the prognosis for these children.

Adult↗