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PubMed2003

Antibiotics to prevent complications following dental implant treatment.

BACKGROUND: Some dental implant failures may be due to bacterial contamination at implant insertion. Infections around biomaterials are difficult to treat and almost all infected implants have to be removed. In general, antibiotic prophylaxis in surgery is only indicated for patients at risk of infectious endocarditis, for patients with reduced host-response, when surgery is performed in infected sites, in cases of extensive and prolonged surgical interventions and when large foreign materials are implanted. To minimise infections after dental implant placement various prophylactic systemic antibiotic regimens have been suggested. More recent protocols recommended short term prophylaxis, if antibiotics have to be used. With the administration of antibiotics adverse events may occur, ranging from diarrhoea to life-threatening allergic reactions. Another major concern associated with the widespread use of antibiotics is the selection of antibiotic-resistant bacteria. The use of antibiotics in implant dentistry is controversial. It would be useful to know whether prophylactic antibiotics are effective in reducing failures of dental implants. OBJECTIVES: To assess the beneficial or harmful effects of the administration of prophylactic antibiotics for dental implant placement versus no antibiotic/placebo administration and if antibiotics are of benefit, to find which type, dosage and duration is the most effective. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. We handsearched several dental journals. No language restrictions were applied. Personal contacts and manufacturers of dental implants were contacted to identify unpublished trials. Most recent search: March 2003. SELECTION CRITERIA: Randomised controlled clinical trials (RCTs) with a follow up of at least 3 months comparing the administration of various prophylactic antibiotics regimens and no antibiotics/placebo to patients undergoing dental implant placement. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity). DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were to be conducted in duplicate and independently by two reviewers. Results were to be expressed as random effects models using weighted mean differences for continuous outcomes and relative risk for dichotomous outcomes with 95% confidence interval. Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS: No RCTs were identified. REVIEWER'S CONCLUSIONS: There is not appropriate scientific evidence to recommend or discourage the use of prophylactic systemic antibiotics to prevent complications and failures of dental implants. Even though the present review did not assess the effectiveness of prophylactic antibiotics for patients at risk for endocarditis, it seems sensible to recommend the use of prophylactic antibiotics for patients at high and moderate risk for endocarditis, with immunodeficiencies, metabolic diseases, irradiated in the head and neck area and when an extensive or prolonged surgery is anticipated.

Antibiotic Prophylaxis↗

PubMed2005

Large brains in autism: the challenge of pervasive abnormality.

The most replicated finding in autism neuroanatomy-a tendency to unusually large brains-has seemed paradoxical in relation to the specificity of the abnormalities in three behavioral domains that define autism. We now know a range of things about this phenomenon, including that brains in autism have a growth spurt shortly after birth and then slow in growth a few short years afterward, that only younger but not older brains are larger in autism than in controls, that white matter contributes disproportionately to this volume increase and in a nonuniform pattern suggesting postnatal pathology, that functional connectivity among regions of autistic brains is diminished, and that neuroinflammation (including microgliosis and astrogliosis) appears to be present in autistic brain tissue from childhood through adulthood. Alongside these pervasive brain tissue and functional abnormalities, there have arisen theories of pervasive or widespread neural information processing or signal coordination abnormalities (such as weak central coherence, impaired complex processing, and underconnectivity), which are argued to underlie the specific observable behavioral features of autism. This convergence of findings and models suggests that a systems- and chronic disease-based reformulation of function and pathophysiology in autism needs to be considered, and it opens the possibility for new treatment targets.

Animals↗

PubMed2005

Recruitment, genetic counseling, and BRCA testing for underserved women at a public hospital.

Genetic counseling and testing for heritable susceptibility to breast cancer caused by mutations in BRCA genes are largely unavailable to underserved women in the United States. Starting in 2002 the UCSF Cancer Risk Program offered this service free of charge to poor and medically indigent women at San Francisco General Hospital (SFGH). One recruitment strategy was a single-page questionnaire in four languages administered to women waiting for mammograms at SFGH. This report analyzes our first 3 years of experience with the recruitment questionnaire and compares the patient demographics and BRCA test results at SFGH with a more typical population undergoing genetic counseling and testing at UCSF's Mt. Zion Hospital (MZH). To our knowledge this is the first comprehensive clinical service for hereditary breast cancer in a U.S. public hospital. The ethnic mix of all 350 patients counseled was Caucasian 49% (approximately 20% of Caucasians reported Ashkenazi Jewish ancestry), Latina, 26%; African American, 13%; and Asian/other, 12%. Compared to the MZH population, SFGH patients were more ethnically diverse, less educated and more likely to be unemployed. Of 72 patients tested for BRCA mutations, 51 (71%) were negative, 5 were BRCA1 positive, and 12 were BRCA2 positive. Four (1 Caucasian, 1 Latina, 2 African American) had a total of 13 BRCA variants of unknown significance (VUS). The ratio of BRCA1/BRCA2 positive SFGH patients (5/12) was reversed compared to MZH (119/91). We evaluated 4573 recruitment questionnaires and 280 (6%) were judged to represent a high risk of heritable cancer. After additional screening and referral negotiation, 74 were scheduled for counseling. We judged the recruitment questionnaire to be a feasible, efficient, and reasonably cost-effective way to identify women at high risk of hereditary cancer in a traditionally underserved population. Underserved populations present special challenges for genetic counselors because of large, geographically dispersed families, cultural taboos about cancer diagnoses, and social marginalization. Despite these complexities, the clinical service at SFGH has been well accepted by patients and staff. Our successful venture can serve as a model for other public hospitals contemplating this clinical service.

Adult↗

PubMed1994

University of Alberta norms of relative meaning frequency for 566 homographs.

For many models of lexical ambiguity resolution, relative frequency of the different meanings of homographs (words with more than one meaning) is crucial. Although several homograph association norms have been published in the past, none has involved a large number of subjects responding to a large number of homographs, and most homograph norming studies are now at least a decade old. In Experiment 1, associations to 566 homographs were collected from an average of 192 subjects per homograph. Frequency of occurrence for the three most common meanings is reported, along with the corresponding associates, and a measure of the overall ambiguity of each homograph. Homographs whose meanings differed in part of speech were more ambiguous overall than homographs whose different meanings belonged to a single grammatical class. Homographs whose pronunciation depended on meaning (heterophones) were no more ambiguous than nonheterophones, and word frequency was unrelated to overall ambiguity. Estimates of homograph balance across different norming studies were compared, and homographs with two meanings of approximately equal relative meaning frequency (balanced homographs) and homographs with one clearly dominant meaning (polarized homographs) were identified. In Experiment 2, reliability of meaning categorizations was measured for a subset of the homographs in the first experiment. Meaning categorizations were shown to be highly reliable across raters.

Humans↗

PubMed1999

Acoustical and perceptual study of gemination in Italian stops.

On the basis of theoretical considerations and results from acoustic and perceptual analyses, it is hypothesized that closure duration is the primary cue for gemination in Italian. Results of an acoustic analysis of a large number of single and geminate Italian utterances show two acoustic correlates of gemination: the length of the closure and the length of the vowel preceding the consonant. Other acoustic parameters were not systematically related to gemination. These results were validated perceptually. At the perceptual level, the above cues were used by the listeners in the geminate/nongeminate discrimination; however, closure duration played a major role. Moreover, it was found that the significant lengthening of consonant was only partially compensated by the shortening of the previous vowel and by a small lengthening of the geminate utterance with respect to the nongeminate one. This result suggests that speakers follow a sort of timing (rhythm) which is fixed in duration and depends on the number of syllables in the word: words with equal numbers of syllables do not change in utterance length, an elongated segment being partly compensated by the shortening of another. This process seems to be applied also perceptually suggesting that the timing (rhythm) of a language is also an auditory attitude.

Adult↗

PubMed1990

Can children use a verb without exposure to its argument structure?

We hypothesize that canonical sentence schemas (e.g. Agent-verb-Patient) can sometimes assign argument structure to verbs. In particular, they provide a default argument structure early in learning when a verb's lexical entry may record the nature of the action but lack a specific argument structure. To test the theory and its application to causative verb errors (e.g. stay it there), novel action verbs were modelled, some as causative, some as intransitive, and some unmarked for transitivity. Spontaneous usage was recorded, along with responses to agent-questions ('What is the [Agent] doing?') and patient-questions ('What is the [Patient] doing?'). Comparable data were obtained for familiar English verbs, some of fixed and some of optional transitivity. Subjects were willing to use all novel verbs both transitively and intransitively, although adults respected assigned transitivity more than children. All subjects largely respected the transitivity of familiar verbs. The discourse pressure of the agent- and patient-questions greatly affected observed transitivity. No evidence was found for the intransitive-to-causative derivational process postulated by Bowerman. We propose that the kind of causativity error observed by Bowerman is due to assignment of argument structure from canonical sentence schemas, especially under pressure of a need to make a sentence with a particular argument (Agent or Patient) as subject. The theory has the advantage of explaining errors without postulating the acquisition of erroneous lexical entries that have to be unlearned, and it can be extended to other kinds of errors in the choice and placement of arguments.

Adult↗

PubMed2000

[Sociocultural dimension of epilepsy (kirikirimasien) in a Bambara rural area (Mali)].

The anthropological study of kirikirimasien (epilepsy) in Mali constitutes an integral part of a research programme devoted to the epidemiology of epilepsy and onchocerciasis in Mali. This programme is run jointly by scientists of the Ecole Nationale de Médecine et de Pharmacie (National School of Medicine and Pharmacy) of Bamako, Mali, and the Faculté de Médecine (Faculty of Medicine) of Marseilles, France. Preliminary results of the anthropological study are presented, based on the qualitative analysis of 132 interviews, conducted over 6 months. Those interviewed were mainly persons affected by kirikirimasien, but included members of the family circle, traditional healers, and outsiders as well. Participatory interview techniques used the national language bambara. The interviews were unstructured and semi-structured so as to identify themes in the bambara language concerning kirikirimasien. Two dominant trends were identified, concerning the aetiology and nosography of the disease, and the social dimension of kirikirimasien, respectively. In terms of aetiology and nosography, diagnosis, contamination and appelation are--in order of priority--the most important aspects of the disease. Yet the social dimension of kirikirimasien appears largely to surpass its aetiological and nosographic aspects. The social dimension is crucial to the anthropological understanding of kirikirimasien. This was amply illustrated by various references which arose during the interviews. First, how is the notion of contamination represented and which practices are associated with it? Second, invalidity and handicap appear to play an essential role in the way people deal with the disease. The notion of tolerance in the bambara environment is also addressed, mainly through a spatial study of the adherence of the person affected by the disease (family, village and outsiders). The third part of the study deals with the social understanding of kirikirimasien and looks at how those affected are cared for, both within their social setting and in terms of seeking treatment.

Anthropology, Cultural↗

PubMed2006

Long-term antibiotics for preventing recurrent urinary tract infection in children.

BACKGROUND: Acute urinary tract infection (UTI) is common in children. By the age of seven 8.4% of girls and 1.7% of boys will have suffered at least one episode. Symptoms include fever, lethargy, anorexia, and vomiting. UTI is caused by Escherichia coli in over 80% of cases and treatment consists of a course of antibiotics. Due to acute illness caused by UTI and the risk of pyelonephritis-induced permanent kidney damage, many children are given long-term antibiotics aimed at preventing recurrence. OBJECTIVES: To determine the efficacy and harms of long-term antibiotics to prevent recurrent UTI in children. SEARCH STRATEGY: We searched without language restriction MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, the Cochrane Renal Group's Specialised Register, reference lists of review articles and contacted content experts. Date of most recent search: January 2006 SELECTION CRITERIA: Randomised comparisons of antibiotics with other antibiotics, placebo or no treatment to prevent recurrent UTI. DATA COLLECTION AND ANALYSIS: Two authors independently assessed and extracted information. A random-effects model was used to estimate relative risk (RR) and risk difference (RD) for recurrent UTI with 95% confidence intervals (CI). MAIN RESULTS: Eight studies (618 children) were identified, five (406) comparing antibiotics with placebo/no treatment. The duration of antibiotic prophylaxis treatment varied from 10 weeks to 12 months. Compared to placebo/no treatment, antibiotics reduced the risk of repeat positive urine culture (RR 0.44, 95% CI 0.19 to 1.00; RD -30%, 95% CI -56% to -4%) No side effects were reported. One study reported that nitrofurantoin was more effective than trimethoprim in preventing recurrent UTI over a six month period (RR 0.48, 95% CI 0.25 to 0.92; RD -18%, 95% CI -34% to -3%). However, patients receiving nitrofurantoin were more likely to discontinue the antibiotic due to side effects (mainly gastrointestinal) (RR 3.17, 95% CI 1.36 to 7.37; RD 22%, 95% CI 8% to 36%). The other study found cefixime was more effective in preventing recurrent UTI than nitrofurantoin (RR 0.74, 95% CI 0.13 to 4.10; RD -3%, 95% CI -17% to -12%). However, 62% of patients receiving cefixime experienced an adverse reaction during the first six months of treatment (18/29) while only 26% (8/31) of patients receiving nitrofurantoin reported an adverse reaction. AUTHORS' CONCLUSIONS: Large, properly randomised, double blinded studies are needed to determine the efficacy of long-term antibiotics for the prevention of UTI in susceptible children.

Acute Disease↗

PubMed2005

Restaurant and food shopping selections among Latino women in Southern California.

OBJECTIVE: This study describes and examines determinants of restaurant and food store selections in a sample of Latino women. DESIGN: Data were collected at the baseline home-based interview from women involved in a randomized community trial to improve dietary behaviors. The interview consisted of both a structured interview and the measurements of height, weight, and waist-to-hip ratio. SUBJECTS/SETTING: Participants included 357 Latino women recruited via random-digit dial in the Southern and Central areas of San Diego County, California. Women were included if they were between 18 and 67 years of age, not currently pregnant, and Spanish-language dominant; women were excluded if a family member was on a special diet or was planning to leave the area during the study. STATISTICAL ANALYSES PERFORMED: Means and frequencies were used to describe preference for various types of restaurants and food stores based on the North American Industry Classification System (NAICS). Independent samples t tests examined differences in levels of importance for preferring fast-food vs other restaurants and supermarkets/produce markets vs other grocery stores. Logistic regression models examined correlates of preferring fast-food restaurants vs all other restaurants and preferring supermarkets/produce markets vs all other grocery stores. RESULTS: More women reported eating at fast-food restaurants, followed by full-service restaurants and cafeterias. Younger women, employed women, women living in higher income households, and women living in the United States for a greater number of years preferred fast food. Supermarkets; grocery stores; and discount, bulk-purchase stores were equally represented as the primary food store. Women who lived in smaller households, had a smaller measured body mass, were married, and were more acculturated to the Anglo culture were more likely to shop at supermarkets compared with women who shopped at other grocery stores. CONCLUSIONS: Our findings suggest specific recommendations for targeting dietary interventions for the growing Latino population that take into account differences in levels of acculturation. For example, young Latino women who more closely identify with the Anglo culture and/or who report living in the United States for a longer period of time may benefit from targeted information on healthy restaurant behavior. On the other hand, traditional Latino women may benefit from instrumental support interventions such as tours to large supermarkets.

Acculturation↗

PubMed2006

Software for dynamic analysis of tracer-based metabolomic data: estimation of metabolic fluxes and their statistical analysis.

MOTIVATION: Metabolic flux analysis of biochemical reaction networks using isotope tracers requires software tools that can analyze the dynamics of isotopic isomer (isotopomer) accumulation in metabolites and reveal the underlying kinetic mechanisms of metabolism regulation. Since existing tools are restricted by the isotopic steady state and remain disconnected from the underlying kinetic mechanisms, we have recently developed a novel approach for the analysis of tracer-based metabolomic data that meets these requirements. The present contribution describes the last step of this development: implementation of (i) the algorithms for the determination of the kinetic parameters and respective metabolic fluxes consistent with the experimental data and (ii) statistical analysis of both fluxes and parameters, thereby lending it a practical application. RESULTS: The C++ applications package for dynamic isotopomer distribution data analysis was supplemented by (i) five distinct methods for resolving a large system of differential equations; (ii) the 'simulated annealing' algorithm adopted to estimate the set of parameters and metabolic fluxes, which corresponds to the global minimum of the difference between the computed and measured isotopomer distributions; and (iii) the algorithms for statistical analysis of the estimated parameters and fluxes, which use the covariance matrix evaluation, as well as Monte Carlo simulations. An example of using this tool for the analysis of (13)C distribution in the metabolites of glucose degradation pathways has demonstrated the evaluation of optimal set of parameters and fluxes consistent with the experimental pattern, their range and statistical significance, and also the advantages of using dynamic rather than the usual steady-state method of analysis. AVAILABILITY: Software is available free from http://www.bq.ub.es/bioqint/selivanov.htm

Algorithms↗

PubMed2003

Coverage of patient safety terms in the UMLS metathesaurus.

The integration and large-scale analyses of medical error databases would be greatly facilitated by the use of a standard terminology. We investigated the availability in the UMLS metathesaurus of concepts that are required for coding patient safety data. Terms from three proprietary patient safety terminologies were mapped to the concepts in UMLS by an automated mapping program developed by us. From these candidate mappings, the concept that matched its corresponding term was selected manually. The reliability of the mapping procedure was verified by manually searching for terms in the UMLS Knowledge Source Server. Matching concepts in UMLS were identified for less than 27% of the terms in the study dataset. The matching rates of terms that describe the type of error and the causes of errors were even lower. The lack of such terms in the existing standard terminologies underscores the need for development of a standard patient safety terminology.

Humans↗

PubMed2005

The Molecular Biology Toolkit (MBT): a modular platform for developing molecular visualization applications.

BACKGROUND: The large amount of data that are currently produced in the biological sciences can no longer be explored and visualized efficiently with traditional, specialized software. Instead, new capabilities are needed that offer flexibility, rapid application development and deployment as standalone applications or available through the Web. RESULTS: We describe a new software toolkit--the Molecular Biology Toolkit (MBT; http://mbt.sdsc.edu)--that enables fast development of applications for protein analysis and visualization. The toolkit is written in Java, thus offering platform-independence and Internet delivery capabilities. Several applications of the toolkit are introduced to illustrate the functionality that can be achieved. CONCLUSIONS: The MBT provides a well-organized assortment of core classes that provide a uniform data model for the description of biological structures and automate most common tasks associated with the development of applications in the molecular sciences (data loading, derivation of typical structural information, visualization of sequence and standard structural entities).

Algorithms↗

PubMed2006

EPI image reconstruction with correction of distortion and signal losses.

PURPOSE: To derive and implement a method for correcting geometric distortions and recovering magnetic resonance imaging (MRI) signal losses caused by susceptibility-induced magnetic field gradients (SFGs) in regions with large static field inhomogeneities in echo-planar imaging (EPI). MATERIALS AND METHODS: Factors to account for field inhomogeneities and SFGs were added in a traditional EPI equation that was a simple Fourier transform (FT) for expressing the actual k-space data of an EPI scan. The inverse calculation of this "distorted EPI" equation was used as a kernel to correct geometric distortions and reductions in intensity during reconstruction. A step-by-step EPI reconstruction method was developed to prevent complicated phase unwrapping problems. Some EPI images of phantom and human brains were reconstructed from standard EPI k-spaces. RESULTS: All images were reconstructed using the proposed multistep method. Geometric distortions were corrected and SFG-induced MRI signal losses were recovered. CONCLUSION: Results suggest that applying our method for reconstructing EPI images to reduce distortions and MRI signal losses is feasible.

Algorithms↗

PubMed1998

From sequence to structure to literature: the protocol approach to bioinformation.

Until the recent advent of high-throughput experimental data-acquisition in biology, the computational analysis of the biological data was predominantly on an ad hoc basis--i.e., the application of a given piece of software on the biological data depended on the need of the moment. This "functional approach" often resulted in piecemeal computational analysis with large amount of intervening "dead-time". The present high-throughput availability of experimental biological data requires a more streamlined and integrated "protocol approach". In this work, we illustrate such a user-friendly protocol using a common question frequently faced by a wet-lab bench-biologist--"Now that I have a DNA or protein sequence, what can I do with it using a computer?" As phrased, this question is steeped in the functional approach. In contrast, the protocol approach would re-phrase the same question as "Now that I have a DNA or protein sequence, what can a computer do for me?" Our integrating tool can start with a sequence and build a substantial custom data-warehouse of computationally derived sequence information, structure information and relevant published literature, that is continually updated.

Amino Acid Sequence↗

PubMed2005

Investigating the structure of craving using structural equation modeling in analysis of the obsessive-compulsive drinking scale: a multinational study.

BACKGROUND: Currently, there is no agreement among researchers on the definition of craving and its underlying theoretical model. The Obsessive-Compulsive Drinking Scale (OCDS) seems to measure certain aspects of craving, but its theoretical basis remains unclear. The aim of this study was to investigate the structure of alcohol craving, using OCDS data. METHODS: OCDS data from four studies were pooled to obtain a large and heterogeneous sample of 505 participants. All participants were treatment-seeking alcoholics meeting DSM-IV criteria for alcohol dependence. The factor structures of the OCDS previously found were evaluated using confirmatory factor analyses. The goodness of fit of these solutions was compared with those of alternative causal models: an obsessive-compulsive disorder model, an inhibition model, and a cognitive-behavioral model. These alternative models were based on modern theories about craving and were tested in the OCDS data, using structural equation modeling. In this way, the current study replaced simple correlational analysis by a more sophisticated causal way of analyzing the underlying structure of the OCDS items. The best fitting model was selected by comparing the mean discrepancy between the implied and observed matrices of the models. RESULTS: The data showed that the previously reported factor structures had to be rejected. Also, the inhibition model and obsessive-compulsive disorder model did not fit the data. The cognitive-behavioral model showed encouraging fit. Optimizing strategies were applied to further improve the fit of this model, which resulted in a model with close fit to the data. CONCLUSIONS: The causal cognitive-behavioral model proved to be superior. It showed that the OCDS contains many items that do not represent the core concept of craving but instead are indicators for the consequences of craving. From this model, it seems that craving, in a narrow sense, can be reliably assessed with only five items of the OCDS.

Adult↗

PubMed1997

Building a framework for multiple improvement initiatives.

BACKGROUND: As health care organizations struggle to compete and even survive in today's turbulent marketplace, they often juggle a variety of initiatives addressing cost reduction, quality improvement, critical pathways, accreditation, clinical guidelines, strategic planning, and organizational development-each with its own priorities, advocates, methods, and language. EXAMPLE: One large health care system that had adopted continuous quality improvement (CQI) as a major strategy then responded to significant cost pressures with additional initiatives in reengineering, cost reduction, and physician guidelines, with varying connections to the quality language, principles, and methods. The senior leadership committee for the quality initiative undertook the development of a framework to explain the connections among the diverse projects and approaches-a framework still in use after two years. SUMMARY AND CONCLUSION: In this period of enormous change, health care leaders must quickly and effectively mobilize all available resources to optimize organizational effectiveness. Too often, management's response patterns have overemphasized a "splitting" tactic, managing multiple distinct initiatives. The creation of integrated delivery systems, mergers, acquisitions, and alliance exacerbates this problem, as the number of initiatives multiplies in the new organizations. Development and application of an integrating management framework will accelerate the pace of organizational improvement by increasing shared understanding of the current desired states of the organization; linking strategic, cultural, and method needs and behaviors; aligning various management initiatives in relation to organizational goals and one another; increasing the fit of management methods with specific situations; and providing a unifying perspective and language for organizational members to act and learn collaboratively.

Cost Control↗

PubMed2005

Increased neuronal communication accompanying sentence comprehension.

The main purpose of this study was to examine large-scale oscillatory activity and frequency-related neuronal synchronization during the comprehension of English spoken sentences of different complexity. Therefore, EEG coherence during the processing of subject-subject (SS)- and more complex subject-object (SO)-relatives was computed using an adaptive fitting approach of bivariate auto-regressive moving average (ARMA) models which enabled the continuous calculation of coherence in the course of sentence processing with a high frequency resolution according to the dynamic changes of the EEG signals. Coherence differences between sentence types were observed in the theta (4-7 Hz), beta-1 (13-18 Hz) and gamma (30-34 Hz) frequency ranges, though emerging during the processing of different parts of these sentences: gamma differences were evident mainly during the relative clause while theta and beta-1 differed significantly following the end of the relative clause. These findings reveal no simple one to one map between EEG frequencies and cognitive operations necessary for sentence comprehension. Instead, they indicate a complex interplay and dynamic interaction between different EEG frequencies and verbal working memory, episodic memory, attention, morpho-syntactic and semantic-pragmatic analyses, which though distinct often co-occur.

Adult↗

PubMed2001

Public hospitals and substance abuse services for pregnant women and mothers: implications for managed-care programs and Medicaid.

Although an increasing proportion of the US population receives health services through managed care, pregnant women and mothers eligible for Medicaid who are involved with alcohol or other drugs are often excluded from these programs due in large part to lack of information on costs, service needs, and service use. To develop such information policy, service settings, and managed-care plans, the project conducted a national survey using a provider group with experience in caring for this population, the member universe of the National Association of Public Hospitals and Health Systems. The survey requested detailed information on hospital system information, current managed-care arrangements, outcome measurements, financing, service priorities, and service availability. The 81% response rate (n = 95) identified 35 hospital systems providing services to an average of 998 women in 1997. The majority of these systems (69%) reported coordinating care for these patients, but only 26% reported they computerize patient charts. Most use at least one indicator to measure effectiveness, and 50% use at least four. Counseling/education and transportation were seen as key support services, but many acknowledge they are not reimbursed for critical services such as nutrition education. The discussion highlights the need to provide formal support for core support services, to assist in care coordination and provide incentives for developing more sophisticated information, and to specify related services in the state Medicaid contract language.

Attitude of Health Personnel↗