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PubMed1978

Attitudes toward death in adolescent offspring of Holocaust survivors.

Introductory remarks are directed toward a brief review of the literature on the psychological problems of the survivors of the Nazi Holocaust, and the paucity of research on offspring of these survivors. A discussion of three adolescents who were in a residential treatment program in Jerusalem, Israel, is proffered. Biographical data, diagnostic categories, review of TAT responses, their ability or inability in forming relationships, and some examples of dreams are presented. A section is devoted to some general underlying assumptions--including an analysis of the concepts "survivor guilt," "repressed agression," and "isolation of affect".

Adolescent↗
PubMed1989

Use of a computer simulation to evaluate a seminar on child abuse.

A computerized patient simulation was used to evaluate the effectiveness of a seminar on child abuse in changing students' behavior in assessing the problem and developing a treatment plan. The CAMPS system (DACIS Software) was selected because it allows students freedom to follow any pathway in selecting over 500 items of history, physical examination, laboratory, and treatments. In interacting with this simulation, students demonstrated how they integrate their knowledge into a clinical setting. The three-hour seminar covered the topics of physical and sexual abuse, patient neglect, and utilization of community resources for treatment. The control (n = 43) and experimental (n = 38) groups, enrolled in an introductory course in pediatrics, were given references to read about child abuse as part of the core curriculum, but they may or may not have had exposure to patients in their clinical work. Only the experimental group attended the seminar. As part of the course evaluation program, both groups interacted with eight computer simulations, two of which involved cases of child abuse. In the classic case of child abuse, the control and experimental groups had similar results. In the more difficult diagnostic problem (shaken baby), the groups differed significantly in total score, cost of the evaluation, and percentage of correct diagnosis.

Child↗
PubMed1991

Acquisition of mature functional responsiveness in T cells: programming for function via signaling.

The results discussed here provide strong evidence that different T-cell effector gene programs are activated by different signals, and that in several cases their responses to the same exogenous stimuli shift during the development and antigen responses of the cells. T-cell responses are thus conditional and plastic at the individual cell level. In the formalism of the introductory section, the results support elements of Models 2 and 3, and suggest a fusion between them as differentiation is explained in terms of alteration in the relative strengths of different intracellular signaling pathways. Returning to an initial question, how are different functional capabilities assigned nonrandomly to cells with different antigen recognition specificities? This question has not been answered, but it can be reformulated. If all virgin T cells can transiently make IL-2, then we must ask what features of cell biology explain the preferential preservation of IL-2 inducibility in CD4+ cells as opposed to CD8+ cells. If the capacity to induce IL-4 expression is not acquired in the thymus, then we may ask whether the initial opening of this locus depends on a CD4-transmitted signal. Similarly, the CD8 molecule itself might participate in inducing the initial differentiation events that render CTL-p inducible for granzyme C and perforin. This would be in accord with a large literature showing that CD8 engagement is much more important in the initial induction of CTL activity than in the exercise of function by pre-primed CTL effectors. The subtext of each of these "questions", however, is that intrathymic events may not directly affect the genes used by terminal effectors for function at all. They may instead bias a cell's complement of triggering receptors, thus rendering it differentially sensitive to particular signals generated during antigen reception. This view is extreme, and will probably turn out to be an overstatement. But it does inspire a unique set of investigations into the basis of T-cell function. It lends urgency to the question of whether CD4+ and CD8+ cells differ in their G proteins, kinases, or inducible proto-oncogenes. If they do, we can then ask whether such differences themselves arise in the periphery, or whether they can be traced back to thymocytes fresh from positive selection--or before.

Animals↗
PubMed1999

Compartmentalization of signaling in neurons: evolution and deployment.

The localization of signal transduction machinery at synapses is a fundamental organizational feature of the nervous system that allows for highly complex integration of information coding processes. Synaptic communication evolved as multicellular organisms became more complex, and as selection pressures were placed on such organisms such that those capable of responding rapidly and specifically to environmental demands survived. Two obvious advantages of synaptic transmission (as opposed to endocrine or paracrine signaling) are that it provides for rapid intercellular communication over great distances and that it provides a high level of spatial specificity. There are several structural and functional aspects of synapses that set them apart from other cellular compartments, with many of the specializations subserving roles in synaptic signal transduction (e.g., neurotransmitter release from the presynaptic terminal and postsynaptic receptor activation and second messenger production). However, studies of developing nervous systems have shown that many synaptic signaling mechanisms are operative prior to synaptogenesis and play important roles in regulating growth cone behaviors, synaptogenesis, and even programmed cell death. Indeed, the concept that "ontogeny recapitulates phylogeny" can be effectively applied to the evolution of the synapse. As the embryo rapidly grows, neurons must elaborate axons and dendrites, establish functional synaptic connections, and maintain and adjust those connections as the organism matures. The purpose of this introductory article is to set the stage for the following articles by briefly reviewing fundamental aspects of the molecular and cellular biology of synapses in an evolutionary context.

Animals↗
PubMed2005

A distance education in undergraduate dietetic education.

Distance education is an exploding phenomenon that allows people to pursue higher education on their own time, at a pace that meets their needs, in locations where there are no colleges and universities, or where there is not a desired program of study. This study examined the use of distance education in undergraduate dietetic education programs and the opportunities for obtaining an undergraduate degree in dietetics solely via distance education. A survey was sent to all directors (n = 279) of undergraduate programs accredited/approved by the Commission on Accreditation for Dietetics Education to determine the current status and projected future use of distance education in their institutions' on-campus programs. The survey had a 54% response rate. Approximately 32% (n = 150) of undergraduate dietetics programs offer distance education courses in some format. Institutions that offer nondietetics distance education courses were more likely to offer dietetics distance education courses. The most common distance education format utilized in dietetics was 100% Internet courses (48%). The most common distance education dietetics course offered was a basic or introductory nutrition course (31%). From the data of courses offered, or permitted to be transferred, it would not be possible for a student to complete an undergraduate degree in dietetics solely via distance education methodologies at the time this study was conducted.

Education, Distance↗
PubMed1998

Georges Guillain's neurologic exploration of America.

This is a study of the status of American neurology at the beginning of the 20th century as perceived by European neurologist Georges Guillain. Guillain trained in Paris, the international "Mecca" of neurology at that time. Whereas many Americans traveled and studied in Europe, very few European neurologists made the reverse journey to the United States. In 1902 Georges Guillain, age 26, traveled to the United States with the specific aim of evaluating neurologic services in America. Recent access to Guillain's personal travel journal and an article in French that he wrote after his return to Europe provide first-hand documentation of American neurology at the turn of the century from a European perspective. Using introductory references from his teacher, Pierre Marie, Guillain visited New York, Chicago, Boston, Philadelphia, and Baltimore. He studied hospitals, outpatient departments, laboratories, and universities, comparing them with institutions in his native France and other European capitals. Guillain was particularly struck by the creative energy of American neurologists, the broad-ranging programs in research and patient care, and the strong financial support provided by local philanthropists, universities, and governments. Guillain clearly foresaw the rising international role of American neurology and the prominence it would gain by the end of his career in the 1950s.

France↗
PubMedDate not supplied

Human sexuality course evaluation.

A three-day human sexuality program was offered in 1974 to medical, nursing, and graduate psychology students for the second consecutive year at the University of Cincinnati. The program was designed to cover a wide range of topics; supply accurate information; encourage participants to question, explore, and assess their own sexual attitudes; and help participants develop a more tolerant attitude toward sexual beliefs, attitudes, and behaviors of others. The Sexual Knowledge and Attitude Test and an evaluation form were used to measure students' pre- and postcourse knowledge, attitudes, and opinions. The total group of 186 subjects registered a significant difference between mean scores of the pre- and postcourse tests. When examined separately, nursing and medical students showed significant changes in attitudes and knowledge scores. Results of the three-day program were compared with those of a five-day program given the previous year. A profile analysis showed the differences in nursing and medical students in pre- and postcourse scores. An evaluation form demonstrated how each group of students felt about the course. This study documented that human sexuality content should be included in nursing and medical curriculums and demonstrated that an introductory concentrated course is an effective interdisciplinary experience for nursing and medical students.

Attitude of Health Personnel↗
PubMed2005

Making human research safe: why we cannot afford to fail.

This paper was given as a keynote address at the International Conference on Ethics of Intellectual Property Rights and Patents held in Warsaw, Poland on April 23-24, 2004. The address was the introductory presentation to the important topic of protecting individuals who participate in research as research subjects.

Biomedical Research↗
PubMed2002

Group cognitive-behavioral treatment for depressed adolescent offspring of depressed parents in a health maintenance organization.

OBJECTIVE: A randomized, controlled effectiveness trial of group cognitive-behavioral therapy (CBT) for depressed adolescent offspring of depressed parents in a health maintenance organization (HMO) was conducted. METHOD: Potential adult cases were found by reviewing antidepressant medication prescriptions, mental health appointments, and medical charts. Introductory study letters signed by each parent's treating physician were mailed to the appropriate adults. Eligible offspring aged 13 to 18 who met current DSM-III-R criteria for major depression and/or dysthymia were randomly assigned to either usual HMO care (n = 47) or usual care plus a 16-session group CBT program (n = 41). Assessments were conducted at baseline, after treatment, and at 12- and 24-month follow-up. RESULTS: Using intent-to-treat analyses, the authors were unable to detect any significant advantage of the CBT program over usual care, either for depression diagnoses, continuous depression measures, nonaffective measures, or functioning outcomes. CONCLUSIONS: Group CBT does not appear to be incrementally beneficial for depressed offspring of depressed parents who are receiving other mental health care. However, given that many other studies have found positive effects of CBT for youth depression, this single study should not be viewed as evidence that CBT is ineffective overall.

Adolescent↗
PubMed2003

Strategies for increasing physicians', nurses', and mammography technicians' participation in research.

BACKGROUND: Breast cancer screening in physicians' daily practices needs greater emphasis. Increasing provider participation in research in this area can be a challenge as demonstrated in our study to test interventions targeting rural health care providers. METHOD: Recruitment methods for the randomized controlled trial involving 27 counties in the Mississippi River Delta region of Arkansas included the following: introductory letters and return postcards, mailed questionnaires, telephone calls, attendance at local medical staff meetings, and telephoning the primary care offices to set a time to meet the providers at their practice sites. This final recruitment strategy of telephoning the primary care offices and arranging with the office manager to bring a CME/CEU credit program included an on-site demonstration of a CBE technique and a free lunch. RESULTS: Only the final strategy yielded provider participation for the study and was more successful in the experimental than the control counties. Providers in the control group could not receive the education program until after their post-test. CONCLUSION: Successful approaches to enrolling physicians and nurses in a study involve careful use of their time and providing benefits.

Allied Health Personnel↗
PubMed1984

Reducing 'information overload' in the teaching of pharmacology: the '200 Drug List'.

The author in this report describes the development and use of a restricted list of drugs in the medical pharmacology course at the Medical College of Georgia (MCG) School of Medicine. The "200 Drug List" was developed by the author by analyzing recent examinations given to students at the MCG and other places. The list contained 60 percent fewer drugs than had been taught in the course in prior years. Only those drugs on the list appeared on subsequent pharmacology examinations, regardless of the scope of the teaching program. Despite the limited number of drugs that the students were required to learn to satisfy the requirements of the teaching program, the average score for the class on the pharmacology subtest of the National Board of Medical Examiners Part I examination improved each year since the new approach was adopted. The 200 Drug List concept is viewed as an effective way to reduce the "information overload" for students without sacrificing the quality of an introductory course in pharmacology.

Education, Medical, Undergraduate↗
PubMed1994

[Children of psychotic parents--a neglected risk group].

Children of psychotic parents form a special risk group with an increased probability to develop psychiatric disorders. After an introductory presentation of the most important research findings, it is shown that, up to now, children of psychotic parents have not been paid much attention to in the literature. A concept for prevention is introduced that may serve as an orientation for planning and realizing preventive measures for children of psychotic parents. The prevention program comprises interventions aimed to improve coping strategies with the parental psychosis as well as specific preventive interventions to improve the situation of the children. Finally, principles are presented that should be acknowledged by specialists when doing preventive work.

Adolescent↗
PubMed2004

An overlooked alliance: using human factors engineering to reduce patient harm.

BACKGROUND: Although human factors engineering (HFE) is considered only in relationship to the design of medical devices or information systems technology, human factors issues arise in many aspects of work in health care organizations. HFE ANALYSIS: In one scenario, the resuscitation stretcher would not pass through the ED door closest to radiology. Many clinical work spaces were never formally designed for the work currently being performed in them; instead, they were adapted from existing space originally designed for a different use. In a second scenario, infusion pump malfunction was not apparent. The patient experienced a near miss secondary to poor design; users thought that the infusion pump had been turned off when it was not. RECOMMENDATIONS: Health care can significantly benefit from the incorporation of HFE into the workplace. Introductory classes in medical and nursing schools on HFE will assist students in detecting HFE-related issues, making them less likely to suffer with them or overlook them once in clinical practice. More extensive training for patient safety and risk managers, that is, at a minimum, a certificate-level course from an HFE program, would enhance case and root cause analyses since these issues are rarely factored in. CONCLUSION: Collaboration with HFE experts and use of HFE principles may not make health care fool-proof, but it will make it less dependent on improvisation and ingenuity to protect patients from the system's vulnerabilities.

Chest Pain↗
PubMed1994

Reading skill and comprehension of the dietary guidelines by WIC participants.

OBJECTIVE: The purpose of this study was to examine the match between reading skills and comprehension of the 1990 Dietary Guidelines in a Special Supplemental Food Program for Women, Infants, and Children (WIC) group (n = 32) compared with a non-WIC group and to determine which selected factors affected cloze scores. SUBJECTS/SAMPLES: The WIC group consisted of volunteers from WIC voucher pick-up sites, and the non-WIC group comprised women who met the qualification criteria for WIC, except income. METHODS: Reading skills were assessed using the Wide-Range Achievement Test-Revised Level II (WRAT-R). Comprehension skills were measured using the cloze technique. MATERIALS: The introductory section of the Dietary Guidelines, originally written at the 10th-grade level, was simplified to the 7th-grade level for comprehension comparison. RESULTS: The WIC group had a significantly (P < .001) lower reading skill (WRAT-R score = 60.1; 11th-grade level) than the non-WIC group (WRAT-R score = 70.8; college level). Cloze scores from all subjects tested at the 10th-grade level indicated that 75% (n = 24) would be frustrated or need instructional assistance to understand the Dietary Guidelines. Simplification contributed to higher cloze scores. The WRAT-R score was one factor that significantly affected the cloze score (P < .001). Both education level and WRAT-R scores varied significantly between groups; however, analysis of covariance revealed that the effects were identical within both groups. IMPLICATIONS: WRAT-R can be used as a quick screening method for reading-skill level of individuals in WIC programs and other counseling situations. The cloze techniques may be useful for assessing comprehension of specific printed materials. Assessment of reading skill and comprehension by nutrition educators is recommended to increase the likelihood of selecting and/or developing effective materials.

Adolescent↗
PubMed2002

Teaching EBM facilitation using small groups.

The problem-centered, learner-focused, small-group process (PLS) is used by faculty to train learners in evidence-based medicine (EBM). Few affordable and accessible courses exist to train faculty in the PLS process. The results of a novel course to train faculty in the PLS process are described. The course was a one-day workshop consisting of five small group sessions with two facilitators. The participants were seven clinicians and four medical librarians. The initial small-group session was a discussion of concepts and principles related to successful facilitation skills; the subsequent four small groups reinforced these concepts and principles with role-playing and case scenarios using different steps in the EBM process. The course, including the use of the PLS process, scored highly on participant evaluations. The authors conclude that the introductory course effectively taught the PLS process for use in EBM facilitation.

Education, Continuing↗
PubMed1994

Attendance and grades in a human physiology course.

Teaching a lecture course in introductory human physiology with 40-183 students provided an opportunity to test the hypothesis that regular attendance is correlated with higher examination scores. Data on 556 students were recorded during five semesters, each consisting of three classes per week for 14 weeks. The students were in the second year of pharmacy, nursing, physical education, and dental hygiene programs. Attendance was recorded in each class. Regular attendance was encouraged but was not used to influence scores. The maximum possible score was 400 points, based on two 1-h examinations and a 2-h final examination. Examinations consisted of multiple-choice questions derived from reading assignments in a required textbook. Linear regression analysis indicated a small negative relation between total point scores and absences, amounting to an average decrease of 2 points for each absence, or a decrease of 0.5% per absence. Correlation coefficients averaged -0.33. The results suggest that regular attendance was helpful in a statistical sense but was not a decisive factor in learning human physiology as presented in current textbooks.

Education, Medical↗
PubMed2001

Neural computation in urology: an orientation.

Neural computation is a field in which mathematical models are derived from algorithms based loosely on the physiological function of the biological neuron. This paper serves as an introduction to those that follow in this issue of Molecular Urology, which describe actual applications of neural computational modeling in the urologic domain. In this introductory paper, the history of computer technology and the foundations of neural computation are discussed. Methods of determining the accuracy of computation models are reviewed, and a statistical method of evaluating the significance of individual input features to the model's output, a process known as "feature extraction," is presented. Resources that provide free and commercial neural computational programs are cited for those readers interested in applying this technology to their own datasets, and a brief description of the author's neural computational programming environment is included. Finally, deployment of computational models via the Internet and various computer platforms is discussed.

Algorithms↗