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PubMed1975

Essay of any ventilators by means of a pulmonary model with adjustable resistance, compliance and vital capacity.

After a critical study of classic lung models, showing that linear resistances are not faithful nor justified and that pneumotachograph is not a good measuring apparatus because of its inaccuracy (it changes calibration according to the nature of gas mixture and needs integration to determine volumes), authors present their own lung "model". In this model, it is possible to adjust resistance, compliance, vital capacity and residual volume. Parabolic resistances are used, because they more approach physiologic ones. Building of resistances (diaphragms), compliances (rigid tanks with adjustable elements), vital capacity (elastic membrane between two grills) is simple to realise and easy to reproduce. Measures of pressure and volume are given directly by gauges and are insensitive to gas nature, which is important in respiratory physiology. Flow-rates are deducted from volume values. The lung model can be used in a twin-cell shape to show the effects of artificial ventilation in case of pulmonary asymmetry. Examples given underline the interest of having a model with resistances easy to build and an adjustable vital capacity.

Airway Resistance↗
PubMed2007

Creating a robust public health infrastructure for physical activity promotion.

The essential role of physical activity both as an independent protective factor against numerous common chronic diseases and as a means to maintain a healthy weight is gaining increasing scientific recognition. Although the science of physical activity promotion is advancing rapidly, the practice of promoting physical activity at a population level is in its infancy. The virtual absence of a public health practice infrastructure for the promotion of physical activity at the local level presents a critical challenge to control policy for chronic disease, and particularly obesity. To translate the increasing evidence of the value of physical activity into practice will require systemic, multilevel, and multisectoral intervention approaches that build individual capability and organizational capacity for behavior change, create new social norms, and promote policy and environmental changes that support higher levels of energy expenditure across the population. This paper highlights societal changes contributing to inactivity; describes the evolution and current status of population-based public health physical activity promotion efforts in research and practice settings; suggests strategies for engaging decision makers, stakeholders, and the general public in building the necessary infrastructure to effectively promote physical activity; and identifies specific recommendations to spur the creation of a robust public health infrastructure for physical activity.

Exercise↗
PubMed2006

Containing HIV/AIDS in India: the unfinished agenda.

India's HIV epidemic is not yet contained and prevention in populations most at risk (high-risk groups) needs to be enhanced and expanded. HIV prevalence as measured through surveillance of antenatal and sexually transmitted disease clinics is the chief source of information on HIV in India, but these data cannot provide real insight into where transmission is occurring or guide programme strategy. The factors that influence the Indian epidemic are the size, behaviours, and disease burdens of high-risk groups, their interaction with bridge populations and general population sexual networks, and migration and mobility of both bridge populations and high-risk groups. The interplay of these forces has resulted in substantial epidemics in several pockets of many Indian states that could potentially ignite subepidemics in other, currently low prevalence, parts of the country. The growth of HIV, unless contained, could have serious consequences for India's development. India's national response to HIV began in 1992 and has shown early success in some states. The priority is to build on those successes by increasing prevention coverage of high-risk groups to saturation level, enhancing access and uptake of care and treatment services, ensuring systems and capacity for evidence-based programming, and building in-country technical and managerial capacity.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Effect of incomplete crown ferrules on load capacity of endodontically treated maxillary incisors restored with fiber posts, composite build-ups, and all-ceramic crowns: an in vitro evaluation after chewing simulation.

OBJECTIVE: The aim of this study was to compare the fracture resistance of endodontically treated maxillary central incisors with incomplete crown ferrules after chewing simulation. MATERIAL AND METHODS: Forty caries-free maxillary central incisors were divided into 4 groups (n = 10). Endodontic treatment was performed. Teeth were decoronated 2 mm above the cemento-enamel junction (CEJ). Group I (control) provided a 360 degrees circumferential 2-mm ferrule. In group II, a 2-mm ferrule was present on the palatal aspect (status after occlusal overload), and in group III on the facial aspect (status after traumatic injury). In group IV, the ferrule was interrupted by bi-proximal cavitations (simulating caries treatment). The teeth received glass fiber reinforced posts and composite core restorations. All-ceramic crowns were adhesively cemented. Specimens were simultaneously exposed to thermal cycling and mechanical loading (1.2 million cycles; 6,000 cycles 5 degrees/55 degrees C) and finally statically loaded until failure in a universal testing machine (crosshead speed = 1 mm/min). For statistical analysis, the Kruskal-Wallis test was applied followed by the Mann-Whitney U-test as post hoc testing. RESULTS: The median fracture load values (min./max.) were: group I = 502 (326/561), group II = 658 (280/827), group III = 899 (396/1176), and group IV = 360 (279/646). Analysis revealed statistically significant differences between test groups, except between groups I and IV and groups II and IV. CONCLUSIONS: The fracture resistance of endodontically and post/core restored teeth is dependent on the degree of tooth conservation. An incomplete crown ferrule is associated with greater variation in load capacity and, despite high fracture values, inclines to fracture.

Composite Resins↗
PubMed2005

A conceptual model of community capacity development for health promotion in the Alberta Heart Health Project.

PURPOSE: The objective of this study was to derive a conceptual model of community capacity development for health promotion based on the 5-year demonstration phase of the Alberta Heart Health Project. METHOD: Community actions associated with successful implementation and uptake of initiatives in four diverse target sites were identified by case study evaluation. RESULTS: Thirteen common elements of capacity development were found across the projects and categorized to define three primary dimensions of the process: (a) leadership that provided a driving force for implementation, (b) policy making that ensured diffusion and sustainability, and (c) use of local community resources and infrastructure. A conceptual model was constructed using these 3 dimensions and their interactions. CONCLUSION: Effective implementation of community health initiatives to promote heart health can be conceptualized as the involvement of local leadership, policy advocacy, and enhancement of existing infrastructure. The model highlights building these dimensions of community capacity development for health promotion.

Alberta↗
PubMedDate not supplied

Public health preparedness for mass-casualty events: a 2002 state-by-state assessment.

INTRODUCTION: The ongoing threat of a terrorist attack places public agencies under increasing pressure to ensure readiness in the event of a disaster. Yet, little published information exists regarding the current state of readiness, which would allow local and regional organizations to develop disaster preparedness plans that would function seamlessly across service areas. The objective of this study is to characterize state-level disaster readiness soon after September 2001 and correlate readiness with existing programs providing an organized response to medical emergencies. METHODS: During the first quarter of 2002, a cross-sectional survey assessing five components of disaster readiness was administered in all 50 states. The five components of disaster readiness included: (1) statewide disaster planning; (2) coordination; (3) training; (4) resource capacity; and (5) preparedness for biological/chemical terrorism. RESULTS: Most states reported the presence of a statewide disaster plan (94%), but few are tested by activation (48%), and still fewer contain a bioterrorism component (38%). All states have designated disaster operations centers (100%), but few states have an operating communications system linking health and medical resources (36%). Approximately half of states offer disaster training to medical professionals; about 10% of states require the training. Between 22-48% of states have various contingency plans to treat victims when service capacity is exceeded. Biochemical protective equipment for health professionals is lacking in all but one state, and only 10% of states indicate that all hospitals have decontamination capabilities. States with a functioning statewide trauma system were significantly more likely to possess key attributes of a functioning disaster readiness plan. CONCLUSION: These findings suggest that disaster plans are prevalent among states. However, key programs and policies were noticeably absent. Communication systems remain fragmented and adequate training programs and protective equipment for health personnel are markedly lacking. Statewide trauma systems may provide a framework upon which to build future medical disaster readiness capacity.

Bioterrorism↗
PubMed1982

A new hospital library in San Diego: planning and construction.

A new library building at the University of California Medical Center, San Diego provides 7,100 net square feet, seating for 100 readers, and a stack capacity of 23,000 volumes. The building contains three split-level floors with conventional reference and circulation services, a combination of group and single seating, rapid copying machines, audiovisual facilities, a public elevator, and an electronic security system for the protection of library materials. The library, intended primarily for the use of health care professionals and students in their third and fourth years of medical school, serves a teaching hospital and its associated research facilities.

Architecture↗
PubMedDate not supplied

Hospital construction materials: poor shielding capacity with respect to signals transmitted by mobile telephones.

Electromagnetic interference (EMI) with electronic medical equipment by the handsets of mobile telephones is a well documented problem in hospitals. To gain information about how to build an EMI-free hospital and how to make rooms safe for mobile telephone handset use in the hospital building the authors measured the shielding capacities of a concrete wall, concrete blocks, a steel door, and steel-surfaced partition panels. The shielding capacities of these materials were 2-7 dB for the concrete wall, 6-8 dB for the concrete blocks, 19-27 dB for the steel door, and 20-37 dB for the steel-surfaced partition panels. These results indicate that care should be taken to shield electronic equipment from signals coming from neighboring rooms and from those under and above any patient room in which such equipment is in use. Electricity-conductive paint, electricity-conductive wallpaper, and electricity-conductive cloth are examples of inexpensive materials that can increase shielding capacity.

Construction Materials↗
PubMedDate not supplied

District health systems in a neoliberal world: a review of five key policy areas.

District health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity. The relegation in the World Health Report 2000 of primary health care to a 'second generation' reform--to be superseded by third generation reforms with a market orientation--flows from an analysis that is historically flawed and ideologically biased. Primary health care has struggled against economic crisis and adjustment and a neoliberal ideology often averse to its principles. To ascribe failures of primary health care to a weakness in policy design, when the political economy has starved it of resources, is to blame the victim. Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional programme of health worker rehabilitation should be developed as the foundation for health service recovery. District health systems can and should be financed (at least mainly) from public funds. Although in certain situations user fees have improved the quality and increased the utilization of primary care services, direct charges deter health care use by the poor and can result in further impoverishment. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization. Priority setting should be driven mainly by the objective to achieve equity in health and wellbeing outcomes. Cost effectiveness should enter into the selection of treatments for people (productive efficiency), but not into the selection of people for treatment (allocative efficiency). Decentralization is likely to be advantageous in most health systems, although the exact form(s) should be selected with care and implementation should be phased in after adequate preparation. The public health service should usually play the lead provider role in district health systems, but non-government providers can be contracted if needed. There is little or no evidence to support proactive privatization, marketization or provider competition. Democratization of political and popular involvement in health enhances the benefits of decentralization and community participation. Integrated district health systems are the means by which specific health programmes can best be delivered in the context of overall health care needs. International assistance should address communicable disease control priorities in ways that strengthen local health systems and do not undermine them. The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass campaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above all the targets must not retard the development of the district health systems so badly needed by the rural poor.

Community Health Planning↗
PubMed2001

Mitochondrial polarization in rat hippocampal astrocytes is resistant to cytosolic Ca(2+) loads.

The influence of physiological Ca(2+)-inducing stimuli and agents mimicking ischemic conditions on mitochondrial potential was studied in postnatal (P1) hippocampal astrocytes. Cytosolic Ca(2+) loads with characteristic kinetics of rise and duration, detected by Fura-2, were provoked by extracellular Ca(2+) influx, release from InsP(3)-sensitive intracellular stores, or inhibition of the reloading of endoplasmic reticulum Ca(2+) stores. Inhibitors of mitochondrial respiration caused only moderate release of Ca(2+) from intracellular stores, inducing a rise of less than 60 nM. The maximal Ca(2+) rise was found with InsP(3)-mediated responses (500 nM; via ATP) or with ionophore (4-Br-A23187)-mediated Ca(2+) influx from extracellular medium (770 nM). Remarkably, all these agents causing significant rise of cytosolic Ca(2+), only minimally depolarized the mitochondria. Membrane potential of mitochondria was monitored by Rh123 or TMRE. Depolarization was only found with very high cytosolic Ca(2+) levels (above 60 microM; measured by fura FF). These were achieved with external Ca(2+) influx by ionophore in combination with inhibition of glycolysis. Thus, mitochondria in the astrocytes are obviously not sensitive to moderate cytosolic Ca(2+) loads, irrespective of the source of Ca(2+). Furthermore, isolated rat brain mitochondria display a low sensitivity of respiratory activity to Ca(2+), which is consistent with the data obtained with the astrocytes in vitro. The capacity of isolated mitochondria to build up a potential was gradually reduced at low micromolar Ca(2+) and totally compromised only at Ca(2+) concentrations in the 100 microM range.

Adenosine Triphosphate↗
PubMed2000

Going beyond triage in Tajikistan. Health reform in the former Soviet Union.

Tajikistan is among the few countries where life expectancy diminished during the 1990's. To rebuild a health system fractured by economic collapse, political disintegration and civil war, the Essential Hospital Services Project was initiated to restore essential hospital services, encourage structural reform and build the health system's capacity to sustain itself. The article provides an overview of these reform efforts, outlines some of the challenges of health reform in Tajikistan and illustrates the benefits global partnerships can achieve when sharing creative new approaches to health reform.

Canada↗
PubMed2006

Transformation pathways of silica under high pressure.

Network-forming oxides with rigid polyhedral building blocks often possess significant capacity for densification under pressure owing to their open structures. The high-pressure behaviour of these oxides is key to the mechanical properties of engineering materials and geological processes in the Earth's interior. Concurrent molecular-dynamics simulations and first-principles calculations reveal that this densification follows a ubiquitous two-stage mechanism. First, a compact high-symmetry anion sublattice forms, as controlled by strong repulsion between the large oxygen anions, and second, cations redistribute onto the newly created interstices. The same mechanism is observed for two different polymorphs of silica, and in the particular case of cristobalite, is corroborated by the experimental finding of a previously unidentified metastable phase. Our simulations not only clarify the nature of this phase, but also identify its occurrence as key evidence in support of this densification mechanism.

Journal Article↗
PubMed1976

The quandary of quality assessment.

Inevitably, quality assurance reflects the context of which it is a part (e.g., underuse or overuse of services is partly a function of their availability and financing). Thus, it can promote change or rationalize lack of it, save money or cost money. Given the current state of the art, it is imperative to develop quality assurance on an evolutionary path while options are kept open and focus is clearly on outcomes. Also, quality assessment must be conceptualized as a behavioral tool, not a policing mechanism; its scope must be broadened to include the total episode of illness, taking into account life-style and environmental factors, with criteria developed and applied as close to the point of patient care as possible, within broad guidelines; it is essential to build on in-place capacities -- e.g., carrier data -- rather than to create new overlapping systems. Finally, the management setting within which quality assurance functions, in both the public and private sectors, must be improved.

Community Participation↗
PubMed1996

Evolutionary reconstruction of a hairpin deleted from the genome of an RNA virus.

The intercistronic region between the maturation and coat-protein genes of RNA phage MS2 contains important regulatory and structural information. The sequence participates in two adjacent stem-loop structures, one of which, the coat-initiator hairpin, controls coat-gene translation and is thus under strong selection pressure. We have removed 19 out of the 23 nucleotides constituting the intercistronic region, thereby destroying the capacity of the phage to build the two hairpins. The deletion lowered coat-protein yield more than 1000-fold, and the titer of the infectious clone carrying the deletion dropped 10 orders of magnitude as compared with the wild type. Two types of revertants were recovered. One had, in two steps, recruited 18 new nucleotides that served to rebuild the two hairpins and the lost Shine-Dalgarno sequence. The other type had deleted an additional six nucleotides, which allowed the reconstruction of the Shine-Dalgarno sequence and the initiator hairpin, albeit by sacrificing the remnants of the other stem-loop. The results visualize the immense genetic repertoire created by, what appears as, random RNA recombination. It would seem that in this genetic ensemble every possible new RNA combination is represented.

Base Sequence↗