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The GPRIME package: computer programs for identifying the best regions of aligned genes to target in nucleic acid hybridisation-based diagnostic tests, and their use with plant viruses.

The GPRIME (Group PRIMEr design) programs examine aligned sets of gene sequences to discover homologous regions to be targeted in diagnostic tests. The core program moves a 'window' over the aligned sequences and calculates, at each window position, a 'redundancy value', namely the number of sequences that would represent all permutations of the variable sequence positions within that window. Regions with minimal redundancy values may then be targeted in diagnostic tests based on oligonucleotide hybridisation. The likely specificity of tests targeting such regions can be assessed by searching the international databases with those regions using FASTA. The GPRIME programs, which include programs for designing primers to distinguish between two sub-sets of a group of aligned sequences, can be obtained from http://life.anu.edu.au/software.html. We have used GPRIME to design redundant primers for RT-PCR tests to detect all potexviruses and tobamoviruses, and then used these, together with a previously reported pair of primers for the Potyviridae, to screen some Australian orchid collections. Two orchid viruses previously reported from Australia were found; cymbidium mosaic potexvirus was common, but odontoglossum ringspot tobamovirus was not. In addition the recently described ceratobium mosaic potyvirus was found to be common, and three other novel potyviruses were also found.

DNA Primers↗

New programs for advanced training in dental geriatrics.

The unprecedented increase in the number and percentage of Americans who are older than the age of 65 is presenting the health care system with unique diagnostic, therapeutic, fiscal, and ethical challenges. Chronic disease, complex pharmacotherapeutic regimens, and psychosocial and physical dysfunction are prevalent in this age group. The dental profession is faced not only with an increase in the number and complexity of older patients, but with the fact that growing numbers of older patients are retaining a greater proportion of their natural dentitions for longer periods. To help meet the need for increased professional skill to deal with these issues, the Health Resources and Services Administration of the Department of Health and Human Services is supporting 23 medical school based geriatrics training programs, designed expressly for physicians and dentists. The programs offer a mixture of experiences in: clinical care of the elderly in a variety of settings; design and conduct of research relevant to geriatric and gerontologic issues; enhancement of pedagogical skills; and program administration. Physicians and dentists share many of the training experiences, providing both groups with unique insights into the presentation and management of their patients' problems, and an enriched awareness of each other's contributions to the care of the elderly.

Aged↗

A design for interlaboratory quality-control programs.

A design for interlaboratory quality-control programs is described. Speimens are despatched in pairs to participating laboratories. The results returned by laboratories are compared with each other and with reference results, but the frequent brief reports which are prepared are not regarded as the main laboratory assessments, although these reports can alert laboratories to gross imprecision and inaccuracy. When sufficient results have been returned, a linear regression analysis is carried out between results from each laboratory and the reference results. The statistics obtained from the regression data provide a concise source of information about the form of inaccuracy (imprecision and systematic error) present.

Chemistry, Clinical↗

Measuring outcomes in children's rehabilitation: a decision protocol.

OBJECTIVE: To develop and test the feasibility and clinical utility of a computerized self-directed software program designed to enable service providers in children's rehabilitation to make decisions about the most appropriate outcome measures to use in client and program evaluation. DESIGN: A before-and-after design was used to test the feasibility and initial impact of the decision-making outcome software in improving knowledge and use of clinical outcome measures. SETTING: A children's rehabilitation center in a city of 50,000. PARTICIPANTS: All service providers in the children's rehabilitation center. Disciplines represented included early childhood education, occupational therapy, physical therapy, speech and language pathology, audiology, social work, and psychology. INTERVENTION: Using a conceptual framework based on the International Classification of Impairment, Disability, and Handicap (ICIDH), an outcome measurement decision-making protocol was developed. The decision-making protocol was computerized in an educational software program with an attached database of critically appraised measures. Participants learned about outcome measures through the program and selected outcome measures that met their specifications. The computer software was tested for feasibility in the children's rehabilitation center for 6 months. OUTCOME MEASURES: Knowledge and use of clinical outcome measures were determined before and after the feasibility testing using a survey of all service providers currently at the centre and audits of 30 randomly selected rehabilitation records (at pretest, posttest, and follow-up). RESULTS: Service providers indicated that the outcomes software was easy to follow and believed that the use of the ICIDH framework helped them in making decisions about selecting outcome measures. Results of the survey indicated that there were significant changes in the service providers' level of comfort with selecting measures and knowing what measures were available. Use of outcome measures as identified through the audit did not change. CONCLUSIONS: The "All About Outcomes" software is clinically useful. Further research should evaluate whether using the software affects the use of outcome measures in clinical practice.

Child↗

A new frontier: applying comprehensive DM strategies to healthy members.

Extend disease management services to 'healthy' members. Why? Because with all the emphasis on high-cost, chronically ill patients, a health plan's most valuable asset is being ignored. At least that's the case being made by Nashville, TN-based American Healthways, which has rolled out a new program designed to put health plans in touch with all their members, not just the chronically ill. Through the use of predictive modeling, the program is designed to target higher risk members so preventive strategies can be employed.

Disease Management↗

US military smallpox vaccination program experience.

CONTEXT: The United States recently implemented smallpox vaccination of selected military personnel in a national program of preparedness against use of smallpox as a biological weapon. The resumption of smallpox vaccinations raises important questions regarding implementation and safety. OBJECTIVE: To describe the US military smallpox vaccination program. DESIGN: Descriptive study of the vaccination program from its inception on December 13, 2002, through May 28, 2003. SETTING: US Department of Defense (DoD) fixed and field medical treatment facilities on multiple continents and ships at sea. SUBJECTS: US service members and DoD civilian workers eligible for smallpox vaccination. MAIN OUTCOME MEASURES: Numbers of vaccinations and rates of vaccination exemptions, symptoms, and adverse events. Data were collected via reports to headquarters and rigorous surveillance for sentinel events. RESULTS: In 5.5 months, the DoD administered 450 293 smallpox vaccinations (70.5% primary vaccinees and 29.5% revaccinees). In 2 settings, 0.5% and 3.0% of vaccine recipients needed short-term sick leave. Most adverse events occurred at rates below historical rates. One case of encephalitis and 37 cases of acute myopericarditis developed after vaccination; all cases recovered. Among 19 461 worker-months of clinical contact, there were no cases of transmission of vaccinia from worker to patient, no cases of eczema vaccinatum or progressive vaccinia, and no attributed deaths. CONCLUSIONS: Mass smallpox vaccinations can be conducted safely with very low rates of serious adverse events. Program implementation emphasized human factors: careful staff training, contraindication screening, recipient education, and attention to bandaging. Our experience suggests that broad smallpox vaccination programs may be implemented with fewer serious adverse events than previously believed.

Adolescent↗

Reinventing fidelity: the transfer of social technology among settings.

In an ideal world, effective programs would be disseminated on a large scale, but many obstacles block program diffusion. To date, little guidance has been provided by program designers on how to implement the program in different sites with different personnel and client populations. This article discusses the debate between the "fidelity camp" and the "reinvention camp" and suggests an approach that reconciles the two positions: fidelity should be maintained to the program's mechanism of operation; reinvention is permitted in implementation if the causal mechanism is preserved. Such an approach is essential for effective dissemination of preventive interventions that are successful in controlled trials.

Adolescent↗

Roman Catholic Church-sponsored natural family planning services in the United States.

OBJECTIVES: Our objective was to determine the level and quality of natural family planning service provided by Roman Catholic Diocese-related programs in the United States. STUDY DESIGN: Programs volunteered quarterly data for five years, using least squares regression we estimated service levels for programs never reporting. RESULTS: From 1988 to 1992, 78 dioceses ever reported and 96 never reported. The majority of clients were avoiding pregnancy and receiving follow-up. An average of 18,061 women were taught by these programs each year in the reporting period. CONCLUSION: Without greater commitment of resources, it is likely that NFP will continue to be a marginal method of family planning in the United States.

Catholicism↗

Medicaid payment for telerehabilitation.

OBJECTIVE: To assess current payment practice for telerehabilitation in state Medicaid programs. DESIGN: Telephone survey. SETTING: State Medicaid programs. PARTICIPANTS: State Medicaid directors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Descriptive. RESULTS: Half of the 35 state Medicaid programs contacted reimbursed at least some telemedicine services other than radiology in 2002. The primary reason for reimbursing for telemedicine is to make services available when there is no local practitioner. Consultation and evaluation and management services were most likely to be reimbursed (12 states). Seven state programs reimbursed telepsychology, and 4 states reported reimbursing for telespeech and language pathology, physical therapy, or occupational therapy. CONCLUSIONS: Telemedicine helps Medicaid programs deliver specialized care to locations with provider shortages. Telerehabilitation is not yet widespread, despite its potential benefit to people with disabilities who cannot travel to a clinic for rehabilitation therapy. Most Medicaid programs calculate the financial costs and patient benefits when considering payment policies, and about half of states require a state law to allow payment for telerehabilitation. Minnesota, Hawaii, and Nebraska, among the responding states, currently reimburse for telerehabilitation. Research is needed to evaluate the appropriateness of telerehabilitation for Medicaid beneficiaries.

Current Procedural Terminology↗

Factors relating to a successful cryopreserved blastocyst transfer program.

OBJECTIVE: To review the authors' experience in a successful frozen blastocyst program. DESIGN: Retrospective study. SETTING: University IVF program. PATIENTS: Women of all ages undergoing 64 frozen blastocyst nondonor thaw cycles. INTERVENTION(S): Thaw cycles with day 5 or day 6 frozen blastocysts replaced into luteal day 5 endometrium in natural or programmed cycles; cryopreservation of blastocysts by Menezo two-step protocol and Testart slow cool program; thawing by two step thaw protocol. MAIN OUTCOME MEASURE(S): Implantation, clinical pregnancy, and delivery rates. RESULT(S): The implantation rate was 16% and was similar with day 5 frozen blastocysts and day 6 frozen blastocysts cycles. The clinical pregnancy rate was 36% and the delivery rate was 27%, with no significant difference between day 5 and 6 blastocysts. CONCLUSION(S): Blastocyst cryopreservation is a viable option for patients of all ages and complements fresh blastocyst culture and transfer. The presence of good quality blastocysts for freezing on day 5 and day 6 yields comparable results and is critical for the success of thaw cycles.

Blastocyst↗

Program development for promoting adherence during and after exercise therapy for urinary incontinence.

This paper presents the development process of a health education program to promote adherence to a pelvic floor muscle exercise (PFME) therapy for women with urinary incontinence (UI). The development process started with a needs assessment phase in which the health problem, health-related quality of life, and behavioral and environmental determinants were assessed. Guided by the intervention mapping (IM) approach, program objectives were formulated and, on the basis of both empirical and theoretical data, intervention methods for influencing determinants of adherence to PFME therapy were chosen and translated into practical strategies. This information was assimilated to a transparent description of the program design. The theoretical rationale of the program was based on the transtheoretical model, the self-regulation theory and principles of targeted communication and sex-specific health care.

Exercise Therapy↗

Mortality impact of an integrated community cardiovascular health program.

BACKGROUND: Preventing cardiovascular disease through community interventions makes theoretical sense but has been difficult to demonstrate. We set out to determine whether a community cardiovascular health program had an impact on mortality. DESIGN: Program evaluation plus ecologic observational analysis of program encounters and mortality rates with external comparisons. SETTING: Franklin County and two comparison counties in rural Maine. PARTICIPANTS: Program encountered >50% of regional adults, broadly distributed by site, gender, and age. INTERVENTIONS: From 1974 to 1994, a community program, integrated with primary medical care and staffed by professional nurses, provided education, screening, counseling, referral, tracking, and follow-up for cardiovascular risk factors. MAIN OUTCOME MEASURES: Age-adjusted mortality rates (total, heart, coronary, cerebrovascular, cancer) for three counties and Maine, plus annual program encounters. RESULTS: Relative to Maine, the Franklin heart disease death rate was 0.97 at baseline (1960-1969; 95% confidence interval, 0.91 to 1.03), 0.91 during the program (0.85 to 0.97), 0.83 during the 11 years of program growth (0.78 to 0.88), but 1.0 during the 10 years of decreasing encounters. Franklin's total death rate was 1.01 at baseline, 0.95 during the program (0.92 to 0.98), and 0.90 during program growth (0.86 to 0. 94). Results were similar for coronary disease, stroke, and cancer. Relative death rates did not fall in either comparison county. Nurse-client encounters totaled 120,280 over 21 years. Relative to Maine, heart disease death rates correlated inversely with program encounters (r = -0.53) but not with unemployment or physician supply. CONCLUSIONS: Integrated with primary medical care, a comprehensive, nurse-mediated community cardiovascular health program in rural Maine has been associated with significant time-dependent and dose-dependent reductions in cardiovascular and total mortality.

Adult↗

A validation study on the practical use of automated de novo design.

The de novo design program Skelgen has been used to design inhibitor structures for four targets of pharmaceutical interest. The designed structures are compared to modeled binding modes of known inhibitors (i) visually and (ii) by means of a novel similarity measure considering the size and spatial proximity of the maximum common substructure of two small molecules. It is shown that the Skelgen algorithm generates representatives of many inhibitor classes within a very short time and that the new similarity measure is useful for comparing and clustering designed structures. The results demonstrate the necessity of properly defining search constraints in practical applications of de novo design.

Algorithms↗

RN to BSN education: what do RNs think?

While most employers want more baccalaureate prepared registered nurses (RNs) in their staffing mix, returning to school is not easy for the RN. This qualitative program evaluation study explores the perceptions of 6 RNs who completed an on-campus, part-time baccalaureate program. Findings reveal that while these RNs originally questioned the value of further education, degree completion had a positive impact on their personal and professional lives. Implications for RN to BSN program design and recruitment into formal education programs are presented.

Adult↗

Youth access to tobacco in two communities.

PURPOSE: To describe the availability of tobacco to youth in two urban communities, as a basis for designing a community-based intervention program. DESIGN: Two Midwestern U.S. urban communities were the setting for unannounced tobacco compliance checks. The population of retailers for this study included all convenience stores, grocery stores, pharmacies, and discount stores licensed by the state to sell tobacco products in the two communities. Establishments where entry is restricted to adults were not included. The total population of retailers was used as the sample, and two purchases were attempted at each retail outlet. METHODS: Cigarette purchases by female teens and the location of cigarettes in stores were documented. Compliance-check procedures were planned with needed protections for retailers and youth. FINDINGS: Adolescent tobacco purchase rates were near the federal recommendations for the two urban communities. Retailer use of self-service displays was higher than expected. Availability of the designated brand for self-service was significantly associated with the purchase rate of tobacco by underage youth. CONCLUSIONS: Self-service displays provide increased availability of tobacco to teens. Teen smoking and youth access to tobacco could be limited by legislation and policies to restrict retailer use of self-service displays.

Adolescent↗

Day hospital/crisis respite care versus inpatient care, Part I: Clinical outcomes.

OBJECTIVE: The authors investigated the clinical feasibility and the outcome for patients of a program designed as an alternative to acute hospitalization. METHOD: This was a random-design study comparing a conventional inpatient program for urban, poor, severely ill voluntary patients who usually require hospitalization to an alternative experimental program consisting of a day hospital linked to a crisis residence. Patients were assessed with standardized measures of symptoms, functioning, social adjustment, quality of life, and satisfaction with clinical services upon admission to the study, at discharge from the index admission, and at follow-ups 2, 5, and 10 months after discharge. RESULTS: One hundred ninety-seven patients were enrolled in the 2-year research program and followed for 10 months. Of the voluntary patients who would have been admitted to the hospital, 83% were appropriate for the experimental program. The clinical, functional, social adjustment, quality of life, and satisfaction outcome measures were not statistically different for the patients in the two treatment conditions; however, there was a slightly more positive effect of the experimental program on measures of symptoms, overall functioning, and social functioning. CONCLUSIONS: The experimental condition, a combined day hospital/crisis respite community residence, seems to have had the same treatment effectiveness as acute hospital care for urban, poor, acutely ill voluntary patients with severe mental illness.

Community Mental Health Services↗

Prevention of depressive symptoms through the use of distance technologies.

Psychoeducational materials can be disseminated at minimal expense through the use of distance technologies, offering an opportunity for prevention. The objective of this project was to develop and evaluate a psychoeducational computer program designed to prevent depressive symptoms. The program was accessible through the Internet or by touch-tone telephone. A total of 786 participants were randomly assigned either to the preventive intervention or to an information-only control condition. Over a three-month follow-up period, no differences between the groups were observed. However, three of the target variables (cognitive style, activity level, and sleep quality) were found to be strong predictors of whether a participant had an episode of major depression during the follow-up period.

Adult↗

Planned development and evaluation of AIDS/STD education for secondary school students in The Netherlands: short-term effects.

This study evaluated the effects of an AIDS/STD curriculum for 9th- and 10th-grade students in the Netherlands. Curriculum development was based on (1) theory-based need assessments among students and teachers, (2) pilot testing of data-based and theory-based methods and materials, and (3) cooperation between researchers and students, teachers, and gatekeepers within the school system. Using a quasi-experimental design, program effects on students' attitudes, beliefs, and sexual behavior were compared with those of current AIDS/STD education practice. The results indicated that the experimental curriculum had a stronger favorable impact on students' attitudes and beliefs regarding using condoms consistently. Regarding sexual risk behavior, a differential curriculum effect could be demonstrated. These findings support the contention that current AIDS/STD education can be improved by (1) using empirical data, (2) applying multiple theories from the social sciences, and (3) involving representatives within the school system in the development process.

Acquired Immunodeficiency Syndrome↗