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PubMed2004

A brief overview of carbon sequestration economics and policy.

This article provides an overview of the issues and challenges involved in analyzing the costs and program design for carbon sequestration. The first section examines some of the pitfalls of comparing the results of carbon sequestration cost studies and suggests some simple ways in which analysts could make their results more useful. The pitfalls in comparing studies include different definitions for the summary statistic "dollars per ton," differences in the type of costs that are estimated, and differences in underlying assumptions regarding program design and implementation. Future cost studies will benefit from improved treatment of leakage, general equilibrium interactions, and public finance interactions. The second section reviews issues related to the implementation of a carbon sequestration program, including which policy tools are available and which have received the most attention, some of the challenges for using those policy tools, and one alternative that has received little attention, but may become necessary. The discussion also provides an overview and analysis of the bills introduced in the last two congresses and considers the general policy implications of those proposals.

Carbon↗
PubMed2000

Computer support for interpreting family histories of breast and ovarian cancer in primary care: comparative study with simulated cases.

OBJECTIVES: To evaluate the potential effect of computer support on general practitioners' management of familial breast and ovarian cancer, and to compare the effectiveness of two different types of computer program. DESIGN: Crossover experiment with balanced block design. PARTICIPANTS: Of a random sample of 100 general practitioners from Buckinghamshire who were invited, 41 agreed to participate. From these, 36 were selected for a fully balanced study. INTERVENTIONS: Doctors managed 18 simulated cases: 6 with computerised decision support system Risk Assessment in Genetics (RAGs), 6 with Cyrillic (an established pedigree drawing program designed for clinical geneticists), and 6 with pen and paper. MAIN OUTCOME MEASURES: Number of appropriate management decisions made (maximum 6), mean time taken to reach a decision, number of pedigrees accurately drawn (maximum 6). Secondary measures were method of support preferred for particular aspects of managing family histories of cancer; importance of specific information on cancer genetics that might be provided by an "ideal computer program." RESULTS: RAGs resulted in significantly more appropriate management decisions (median 6) than either Cyrillic (median 3) or pen and paper (median 3); median difference between RAGs and Cyrillic 2.5 (95% confidence interval 2.0 to 3.0; P<0.0001). RAGs also resulted in significantly more accurate pedigrees (median 5) than both Cyrillic (median 3.5) and pen and paper (median 2); median difference between RAGs and Cyrillic 1.5 (1.0 to 2.0; P<0.0001). The time taken to use RAGs (median 178 seconds) was 51 seconds longer per case (95% confidence interval 36 to 65; P<0.0001) than pen and paper (median 124 seconds) but was less than Cyrillic (median 203 seconds; difference 23. (5 to 43; P=0.02)). 33 doctors (92% (78% to 98%)) preferred using RAGs overall. The most important elements of an "ideal computer program" for genetic advice in primary care were referral advice, the capacity to create pedigrees, and provision of evidence and explanations to support advice. CONCLUSIONS: RAGs could enable general practitioners to be more effective gatekeepers to genetics services, empowering them to reassure the majority of patients with a family history of breast and ovarian cancer who are not at increased genetic risk.

Breast Neoplasms↗
PubMed2002

The National Toxicology Program rodent bioassay: designs, interpretations, and scientific contributions.

The National Toxicology Program rodent cancer bioassay program design evolved from that of the National Cancer Institute in the 1970s. Groups of 50 or more mice are assigned to control or treatment groups. Test substances are given at three dose levels by intubation, dietary or drinking water consumption, or dermal or inhalation exposure. Dosing starts at age 5-6 weeks and lasts for 2 years, when surviving animals receive a complete histopathologic examination. Statistical approaches accommodate survival differences and no longer require differentiation between fatal and incidental tumors. Photocarcinogenicity studies, employing SKH-1 hairless mice, evaluate onset of skin papillomas and incidences at 1 year. Top doses are chosen to expose animals to a minimally toxic challenge and lower doses to operate within the linear range of kinetics. This dosing allows comparison of results across studies. Bioassay and ancillary studies successfully identify tumor-causing agents in rodents, provide information on dose-response, and characterize other chemical-related toxicities. NTP and Ramazzini Foundation bioassay designs differ in several aspects, but bioassays at both institutions provide chemical-specific information for predicting human carcinogens, thus providing for protection of public health. Bioassays constitute an essential information reference set for new assay development and further investigations into mechanisms of action. The scientific community and the public owe a huge debt of gratitude to Dr. Cesare Maltoni of the European Foundation of Oncology and Environmental Sciences and to Dr. David P. Rall of the National Institute of Environmental Health Sciences for their foresight and wisdom in creating and nurturing these bioassay programs.

Animals↗
PubMed1996

Implementation of neck/shoulder rehabilitation in primary health care clinics.

OBJECTIVE: To provide primary health care practitioners with the practical information necessary to implement rehabilitation of patients with neck/shoulder pain in clinical facilities. Equipment and program design are discussed in detail. DATA SOURCE: A Medline literature search was performed. English and Scandinavian language references were included in the review. Key words included neck/shoulder pain, neck pain, rehabilitation, equipment, exercise. STUDY SELECTION: The studies selected included clinical trials in which rehabilitation was the main intervention in the treatment of patients with neck/shoulder pain. DATA SYNTHESIS: Reestablishing functional capacities of the musculature of the cervical spine can be accomplished with modest equipment and can be easily incorporated into the clinical setting. The extensors of the cervical spine are the most important muscle group that require rehabilitation and exhibit the highest values in all strength parameters. High-intensity rehabilitative protocols accompanied by the encouragement of fellow patients and support from personnel are essential for treatment success. CONCLUSIONS: Complete primary health care treatment of patients with chronic, recurrent and post-traumatic neck/shoulder pain will necessitate longer rehabilitation programs. Future studies will provide additional information regarding specific program design.

Arthralgia↗
PubMed2003

Multisource feedback in the assessment of physician competencies.

Multisource feedback (MSF), or 360-degree employee evaluation, is a questionnaire-based assessment method in which rates are evaluated by peers, patients, and coworkers on key performance behaviors. Although widely used in industrial settings to assess performance, the method is gaining acceptance as a quality improvement method in health systems. This article describes MSF, identifies the key aspects of MSF program design, summarizes some of the salient empirical research in medicine, and discusses possible limitations for MSF as an assessment tool in health care. In industry and in health care, experience suggests that MSF is most likely to succeed and result in changes in performance when attention is paid to structural and psychometric aspects of program design and implementation. A carefully selected steering committee ensures that the behaviors examined are appropriate, the communication package is clear, and the threats posed to individuals are minimized. The instruments that are developed must be tested to ensure that they are reliable, achieve a generalizability coefficient of Ep2 = .70, have face and content validity, and examine variance in performance ratings to understand whether ratings are attributable to how the physician performs and not to factors beyond the physician's control (e.g., gender, age, or setting). Research shows that reliable data can be generated with a reasonable number of respondents, and physicians will use the feedback to contemplate and initiate changes in practice. Performance may be affected by familiarity between rater and ratee and sociodemographic and continuing medical education characteristics; however, little of the variance in performance is explained by factors outside the physician's control. MSF is not a replacement for audit when clinical outcomes need to be assessed. However, when interpersonal, communication, professionalism, or teamwork behaviors need to be assessed and guidance given, it is one of the better tools that may be adopted and implemented to provide feedback and guide performance.

Clinical Competence↗
PubMed2001

A novel approach for the development of selective Cdk4 inhibitors: library design based on locations of Cdk4 specific amino acid residues.

Identification of a selective inhibitor for a particular protein kinase without inhibition of other kinases is critical for use as a biological tool or drug. However, this is very difficult because there are hundreds of homologous kinases and their kinase domains including the ATP binding pocket have a common folding pattern. To address this issue, we applied the following structure-based approach for designing selective Cdk4 inhibitors: (1) identification of specifically altered amino acid residues around the ATP binding pocket in Cdk4 by comparison of 390 representative kinases, (2) prediction of appropriate positions to introduce substituents in lead compounds based on the locations of the altered amino acid residues and the binding modes of lead compounds, and (3) library design to interact with the altered amino acid residues supported by de novo design programs. Accordingly, Asp99, Thr102, and Gln98 of Cdk4, which are located in the p16 binding region, were selected as first target residues for specific interactions with Cdk4. Subsequently, the 5-position of the pyrazole ring in the pyrazol-3-ylurea class of lead compound (2a) was predicted to be a suitable position to introduce substituents. We then designed a chemical library of pyrazol-3-ylurea substituted with alkylaminomethyl groups based on the output structures of de novo design programs. Thus we identified a highly selective and potent Cdk4 inhibitor, 15b, substituted with a 5-chloroindan-2-ylaminomethyl group. Compound 15b showed higher selectivity on Cdk4 over those on not only Cdk1/2 (780-fold/190-fold) but also many other kinases (>430-fold) that have been tested thus far. The structural basis for Cdk4 selective inhibition by 15b was analyzed by combining molecular modeling and the X-ray analysis of the Cdk4 mimic Cdk2-inhibitor complex. The results suggest that the hydrogen bond with the carboxyl group of Asp99 and hydrophobic van der Waals contact with the side chains of Thr102 and Gln98 are important. Compound 15b was found to cause cell cycle arrest of the Rb(+) cancer cell line in the G(1) phase, indicating that it is a good biological tool.

Adenosine Triphosphate↗
PubMedDate not supplied

Determining crucial correlates of breast self-examination in older women with low incomes.

PURPOSE: To investigate the frequency and proficiency of breast self-examination (BSE) in older women with low incomes and to identify predictors of BSE to facilitate more effective clinical encounters and improved educational programs. DESIGN: Correlational, nonexperimental survey. SETTING: Urban tertiary-care center. SAMPLE: 204 women (ages 40-86) self-referred or recruited from the community for free breast cancer screening. Criteria for inclusion were age 40 or older, a household income of less than two-and-one-half times the poverty level, and uninsured or underinsured status. METHODS: The Mamon and Zapka Breast Self-Examination Survey was modified for use with this population. Telephone surveys were conducted during the period between the initial contact and screening. MAIN RESEARCH VARIABLES: 102 independent variables were correlated with frequency and proficiency. Part correlations were calculated to determine unique contributions. Variables with significant part correlations were entered into regression equations. FINDINGS: The mean frequency and proficiency scores were 2.9 out of 4 and 3.4 out of 19, respectively. Four variables explained 40% of the variance in frequency, and eight explained 66% of the variance in proficiency. Frequency and proficiency were significantly related. CONCLUSIONS: 10 variables were found to predict BSE behavior in this population: confidence, confidence level, awareness of mammography, provider influence, desire for reconstruction, knowledge of parity risk factor, education, having been taught the correct time of month to perform BSE, adequate time devoted to BSE, and exposure to BSE messages from a clinician. IMPLICATIONS FOR NURSING PRACTICE: The study identifies variables to include in clinical encounters and educational programs designed to promote BSE. Of importance is considering the characteristics and specific needs of the recipients of educational and interventional programs.

Adult↗
PubMedDate not supplied

Family education seminars and social functioning of adults with chronic aphasia.

UNLABELLED: Aphasia affects functional activities and participation in social roles years after onset. Some group and individual programs have reported success in improving social activities and perceived wellness. These programs typically last several weeks or months. A short, 2-day seminar style program designed for adults with chronic aphasia and their families is described in this report. Six-month follow-up data from participant pairs demonstrates a significant improvement in functional activity level, improved knowledge of aphasia, and improved family relationships. Nonparticipant pairs did not demonstrate any changes over the same period. These findings replicate and extend those of a previous study on the same 2-day seminar [Top. Stroke Rehabil. 2 (1995) 53.]. The results of this study demonstrate the important outcomes of even a very brief program designed to address the long-term psychosocial needs of adults living with aphasia and their families. EDUCATIONAL OBJECTIVES: As a result of this activity, the participant will be able to: (1) describe a brief family education seminar for adults with chronic aphasia; (2) discuss outcomes in family adjustment, community reintegration, and activities of daily living associated with participation in a family education seminar; and (3) evaluate areas of programming and outcomes that should be addressed in future research.

Aphasia↗
PubMed2005

Tissue engineering of vascular conduits: fabrication of custom-made scaffolds using rapid prototyping techniques.

BACKGROUND: The technique of stereolithography, which automatically fabricates models from X-ray computed tomography or magnetic resonance imaging (MRI) data linked to computer-aided design programs, has been applied to the fabrication of scaffolds for tissue engineering. We previously reported on the application of stereolithography in scaffold fabrication of a trileaflet heart valve. In our current experiment we demonstrate a new technique for the fabrication of custom-made conduits for the potential replacement of a coarcted aortic segment. METHODS AND RESULTS: In this experiment the image data derived from a 12-year-old male patient with aortic coarctation scanned by MRI were processed by a computer-aided design program to reconstruct the aortic arch with isthmus stenosis three dimensionally. By defining the stenotic section and the adjacent normal vessel a custom-made nonstenotic descending aorta was reconstructed to replace the stenosed part. The rapid prototyping technique was used to establish stereolithographic models for fabricating biocompatible and biodegradable vascular scaffolds with the anatomic structure of the recalculated human descending aorta through a thermal processing technique. CONCLUSION: Our results suggest that the re-creation and reproduction of complex vascular structures by computer-aided design techniques may be useful to fabricate custom-made polymeric scaffolds for the tissue engineering of living vascular prostheses.

Aortic Coarctation↗
PubMed2002

Fractional Design Wizard: a computer program for cost-effective experimental research design.

The computer program Fractional Design Wizard creates fractional factorial designs that are cost-effective and especially useful for discarding irrelevant factors from a large number of possible candidates. The program is intended for researchers who are relatively new to the field of fractional design and who want to acquaint themselves with the use of fractions for the reduction of large experimental designs. Fractional designs allow estimation of main effects, and sometimes two-way interactions, without one's having to examine all treatment conditions. The program needs Microsoft Windows 95 or better and 32 MB of memory. In a step-by-step fashion, the user can specify the required properties of the fractional design. When there are more valid designs, the user can generate these successively. If necessary, the user can go back to diminish the requirements. The output can be copied, printed, and saved. The program generates all the information that is needed for the use and interpretation of fractional designs. A help file explains the use of the program and also the purpose, the analysis, and the interpretation of fractional designs. The program, which is written in Object Pascal, is available as freeware on www.fss.uu.nl/ms/hl/fracdes.htm.

Algorithms↗
PubMed1994

Factors responsible for immunizations referrals to health departments in North Carolina.

BACKGROUND: Despite the existence of Medicaid and other programs designed to eliminate cost as a barrier to immunization in physicians' offices, referrals to local health departments for immunizations are common. Many children leave their physicians' offices without receiving needed immunizations. PURPOSE: To determine: 1) the frequency and determinants of immunization referrals to health departments in North Carolina, and 2) the factors associated with private physicians' decisions to immunize Medicaid children in their offices and participate in the state-funded vaccine replacement program. METHODS: The 2537 pediatricians and family physicians licensed in North Carolina were surveyed by mail using a 23-item, self-administered questionnaire. RESULTS: Seventy-two percent of physicians responded; 93% referred at least some children to local health departments for immunizations. Concern regarding parents' ability to pay for immunizations was the most important reason for referral for 93% of respondents. Forty percent referred all or some of their Medicaid patients; excessive paperwork, inadequate reimbursement, and parental preferences were the most common reasons. Only 33% of physicians had participated in the state's vaccine replacement program. Family physicians, and physicians in solo or two-physician practices in rural counties, and in practices caring for a small number of children on Medicaid were most likely to refer children covered by Medicaid and not participate in the state's existing vaccine replacement program. CONCLUSIONS: Medicaid and North Carolina's vaccine replacement program are not preventing large numbers of immunization referrals to health departments. Future programs designed to increase the proportion of children immunized in physicians' offices will not succeed if more effective incentives for physician participation are not developed.

Child↗
PubMed1992

Intuitive user interfaces (IUI): a CASE starting point for design and programming.

The acceptance of a software product depends to a considerable extent on the user interface. The class of graphic-oriented user interfaces that are called Intuitive User Interfaces (IUI) is described. These interfaces allow the user to learn to operate software programs quickly. In the following the graphical layout put to use in an IUI is elaborated. All images the layout consists of are created with the aid of a paint program. Using these images, a procedure for creating, programming and linking an IUI to software applications is discussed and recommendations are made concerning software and hardware demands for easily creating IUIs. Practical experience of the authors with this procedure, mainly in the medical area, is described.

Computer Graphics↗
PubMed1994

A model for resident surgical training in laparoscopic sterilization.

OBJECTIVE: To measure the effects of a specific instructional program designed to teach residents laparoscopic sterilization. METHODS: The teaching module consisted of a 40-minute videotape and monograph, which each resident studied 1-3 days before beginning a 4-5-week rotation on which he or she performed laparoscopic sterilization procedures. The change in knowledge was measured by comparing pre- and post-test assessments. Twenty-three PGY-2 gynecology residents were administered the peer-reviewed and validated pre-test, which consisted of 31 multiple-choice questions covering the following aspects of laparoscopic sterilization: 1) indications and complications, 2) general aspects of sterilization, 3) sterilization methods, and 4) technical aspects of occlusive device application. A post-test, which consisted of the identical 31 items with the question order changed, was administered after the teaching module was completed. RESULTS: The mean number of correct answers on the post-test (27.2 +/- 2.3, range 22-31) was significantly higher (P < .05) than the mean number of correct answers on the pre-test (17.9 +/- 3.4, range 13-24). There was no difference in residence scores if the module was completed early or late in the academic year or during the first or second year that the program was in effect. CONCLUSION: This study demonstrates that knowledge of a specific surgical technique can be measured and that structured learning packages can be effective. Efforts to teach residents a specific curriculum can have a significant effect on their fund of knowledge. Other specially designed programs may be applicable to procedures commonly performed by gynecologic residents.

Curriculum↗
PubMed2006

A heart failure self-management program for patients of all literacy levels: a randomized, controlled trial [ISRCTN11535170].

BACKGROUND: Self-management programs for patients with heart failure can reduce hospitalizations and mortality. However, no programs have analyzed their usefulness for patients with low literacy. We compared the efficacy of a heart failure self-management program designed for patients with low literacy versus usual care. METHODS: We performed a 12-month randomized controlled trial. From November 2001 to April 2003, we enrolled participants aged 30-80, who had heart failure and took furosemide. Intervention patients received education on self-care emphasizing daily weight measurement, diuretic dose self-adjustment, and symptom recognition and response. Picture-based educational materials, a digital scale, and scheduled telephone follow-up were provided to reinforce adherence. Control patients received a generic heart failure brochure and usual care. Primary outcomes were combined hospitalization or death, and heart failure-related quality of life. RESULTS: 123 patients (64 control, 59 intervention) participated; 41% had inadequate literacy. Patients in the intervention group had a lower rate of hospitalization or death (crude incidence rate ratio (IRR) = 0.69; CI 0.4, 1.2; adjusted IRR = 0.53; CI 0.32, 0.89). This difference was larger for patients with low literacy (IRR = 0.39; CI 0.16, 0.91) than for higher literacy (IRR = 0.56; CI 0.3, 1.04), but the interaction was not statistically significant. At 12 months, more patients in the intervention group reported monitoring weights daily (79% vs. 29%, p < 0.0001). After adjusting for baseline demographic and treatment differences, we found no difference in heart failure-related quality of life at 12 months (difference = -2; CI -5, +9). CONCLUSION: A primary care-based heart failure self-management program designed for patients with low literacy reduces the risk of hospitalizations or death.

Adult↗
PubMed1994

Four educational programs in Space Life Sciences.

Four different educational programs impacting Space Life Sciences are described: the NASA/USRA Advanced Design Program, the NASA Specialized Center of Research and Training (NSCORT) Program, the Centers for the Commercial Development of Space (CCDS) Program, and the NASA Graduate Research Fellow Program. Each program makes somewhat different demands on the students engaged in them. Each program, at the University of Colorado, involves Space Life Sciences training. While the Graduate Student Research Fellow and NSCORT Programs are discipline oriented, the Advanced Design and CCDS Programs are focused on design, technologies and applications. Clearly, the "training paradigms" differ for these educational endeavors. But, these paradigms can be made to mutually facilitate enthusiasm and motivation. Discipline-oriented academic programs, ideally, must be flexible enough to accommodate the emergent cross-disciplinary needs of Space Life Sciences students. Models for such flexibility and resultant student performance levels are discussed based upon actual academic and professional records.

Biological Science Disciplines↗
PubMedDate not supplied

Modification of fresh-frozen plasma transfusion practices through educational intervention.

The effect of an educational program designed to address misconceptions about the perioperative transfusion of fresh-frozen plasma (FFP) was examined. Results of a baseline audit of FFP use were compared to those of a study subsequent to the educational process. Statistical analysis of the data revealed that the decrease in the number of patients transfused with FFP, from 32 of 2077 operative cases in Group A (baseline) to 18 of 2540 operative cases in Group B (after education), was significant (p less than 0.01). Analysis of the justifications given for transfusion of FFP revealed that the increase in acceptable indications from 47 percent in Group A to 78 percent in Group B was also significant (p less than 0.05). There was no significant difference between the two groups in units of FFP transfused per patient (Group A, 3.66 +/- 3.2, vs. Group B, 2.47 +/- 1.7) or red cells (Group A, 2.84 +/- 5.2, vs. Group B, 5.22 +/- 4.4), and the patterns of platelet transfusion were similar in the two groups. There was a significant difference in the postoperative partial thromboplastin time (Group A, 38.2 +/- 8.7 vs. Group B, 56.3 +/- 24 seconds, p less than 0.01) but no significant difference in postoperative prothrombin time (Group A, 14.1 +/- 2.6 vs. Group B, 15.4 +/- 3.3 seconds). It can be concluded that an educational program designed to address misconceptions in transfusion practice can alter physician performance and thereby reduce the inappropriate use of FFP.

Blood Transfusion↗
PubMed1998

Seattle YouthCare's prevention, intervention, and education program: a model of care for HIV-positive, homeless, and at-risk youth.

YouthCare's project for youth who are human immunodeficiency virus (HIV)-positive or at high risk for becoming HIV positive is one of 10 supported by Special Projects of National Significance Program, HIV/Acquired Immunodeficiency Syndrome Bureau, Health Resources and Services Administration. Throughout its 23-year history, YouthCare has focused on serving runaway, homeless, sexual minority, and other youth "on the margins." To respond effectively to the needs of these youth, YouthCare has developed creative service approaches including involving youth in program design and taking the programs to where the youth live. Building on this experience, the agency developed a continuum of services which has provided care to 906 youth, including 37 who are HIV positive. The five major elements of the model include: (a) youth-specific HIV antibody test counseling, (b) outreach, (c) intensive case management for HIV-positive youth, (d) prevention services for youth at high risk of HIV infection, and (e) peer involvement. Quantitative evaluation helped in identifying youth served by the project (e.g., over one third self-identify as a sexual minority) and the sites at which services should be provided. Preliminary results from qualitative evaluations have stressed the importance of teamwork in designing clinical interventions and providing support to direct-service staff. This report's conclusion stresses that case management for this population, even though time and resource-intensive, is effective, and that services need to be flexible and tailored to each client's needs.

Acquired Immunodeficiency Syndrome↗