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PubMed2001

American Society of Tropical Medicine and Hygiene--49th annual meeting.

This broad-based meeting covered all areas of tropical medicine, from basic science to clinical aspects, and focused on the perspectives from both Western travelers and public health strategies in developing countries. There was considerable interest in the development, assessment and implementation of antimalarial drug treatments, ranging from the most effective way to use existing compounds, to the strategic arguments associated with the desirability, feasibility and implementation of combination chemotherapy. Finally, attention was focused on the use of molecular markers to track and predict the emergence of antimicrobial drug resistance. Abstracts can be viewed on the ASTMH website, www.astmh.org, or obtained as a supplement to the American Journal of Tropical Medicine and Hygiene.

Journal Article↗
PubMed1966

Extramural programs of theNational Library of Medicine: program objectives and present status.

The National Library of Medicine Extramural Program, utilizing the authorities of the Medical Library Assistance Act of 1965 and the Public Health Service Act, includes support for library construction, improving and expanding basic library resources, research and development, man-power development, publications, and support for the operation of regional health sciences libraries. The program objectives relating to these various activities have been outlined. A $4,000,000 supplement has been appropriated by the Congress for fiscal year 1966 to implement the authorities of the Act. With the construction provision available in fiscal year 1967, over $13,000,000 has been requested for the second year of the program. The Medical Library Assistance Act is intended to catalyze and stimulate expanded support of medical libraries by their host institutions. Bold and imaginative plans by the medical library community are essential to the full success of the endeavor.

Legislation, Medical↗
PubMed1993

The ethics of role conflict in research.

While engaged in interviewing stroke patients, nurses found their research responsibilities conflicting with traditional patient care values. At the termination of the pilot project, the nurses, doubting their role, shared their concerns with the research team. They made recommendations regarding the appropriateness of tools and training needs of research assistants. Unresolved role conflict motivated the nurses to review the literature, seeking answers to the issue. Other nurses have experienced this same conflict. While nursing has been referred to as a profession that complements art with science, in practice, altruism may conflict with maintaining research integrity. The nurse, when functioning as a researcher, may find situations where a choice needs to be made whether to implement nursing interventions or continue the research protocol. The difficulty remains in deciding when the patient advocate role takes precedence over other legitimate concerns. Even though the ANA Code for Nurses with Interpretive Statements requires that the nurse participate in research to advance the profession's body of knowledge, the code's primary principle mandates respect for the rights of the individuals the nurse serves. Research need not be undertaken at the expense of human dignity. If conflicts develop, nursing's primary responsibility is to the individual. Concern for the individual always takes precedence over maintaining research integrity. Nurses are "advocates, where trust, compassion, and empathy encompass all our nursing endeavors, including research" (p. 161). While striving to achieve research goals, nurses must not lose sight of the traditional values inherent in nursing.

Cerebrovascular Disorders↗
PubMedDate not supplied

AIDS, ethics, and the blood supply. A report of a conference of the American Blood Commission and the Hastings Center, Institute of Society, Ethics and the Life Sciences, January 29 and 30, 1985.

Although the conference was not held to determine policy, certain issues emerged which should be of interest to all involved with the initiation of anti-HTLV-III testing. First, there was a consensus that an implementation period during which donors will not be notified of the test results is essential. During this period, test proficiency, data confidentiality safeguards, and positive donor counseling procedures can be established. Also, during this period alternative test sites can be established; this was considered a critical step to maintain the safety of the blood supply. Second, there was a perceived need for legislation to protect the confidentiality of sensitive test data, whether in the laboratory or as part of a deferral list system, from subpoena. Third, there was not agreement about whether inventory should be tested; donors who provided that inventory did not know it was to be tested, and might not have consented if the implications of testing had been known. But, inventory testing is clearly in the interest of the recipient. Finally, there was an awareness in the blood banking community of their new role in monitoring a public health menace, and a beginning acceptance of this role emerged.

Acquired Immunodeficiency Syndrome↗
PubMed2006

The dual-use dilemma for the life sciences: perspectives, conundrums, and global solutions.

The term "dual-use" traditionally has been used to describe technologies that could have both civilian and military usage, but this term has at least three different dimensions that pose a dilemma for modern biology and its possible misuse for hostile purposes: (1) ostensibly civilian facilities that are in fact intended for military or terrorist bioweapons development and production; (2) equipment and agents that could be misappropriated and misused for biological weapons development and production; and (3) the generation and dissemination of scientific knowledge that could be misapplied for biological weapons development and production. These three different aspects of the "dual-use dilemma" are frequently confused--each demands a distinct approach within a "web of prevention" in order to reduce the future risk of bioterrorism and biowarfare. This article discusses the nature of the different perspectives and divergent approaches as a contribution to finding a scientifically acceptable global solution to the problem posed by the dual-use dilemma. We propose that: (1) facilities that are intended for bioweapons development and production should be primarily prevented by a strengthened Biological and Toxin Weapons Convention (BTWC) effectively implemented in all nation states, one that includes provisions for adequate transparency to improve confidence and a mechanism for thorough inspections when there is sufficient cause, and enhanced law enforcement activities involving international cooperation and sharing of critical intelligence information; (2) potentially dual-use equipment and agents should be available to legitimate users for peaceful purposes, but strengthened national biosafety and physical and personnel biosecurity controls in all nations together with effective export controls should be implemented to limit the potential for the misappropriation of such equipment and materials; and (3) information should be openly accessible by the global scientific community, but a culture of responsible conduct involving the breadth of the international life sciences communities should be adopted to protect the ongoing revolution in the life sciences from being hijacked for hostile misuse of the knowledge generated and communicated by life scientists.

Access to Information↗
PubMed2003

Bridging postdoctoral training and a faculty position: initial outcomes of the Burroughs Wellcome Fund Career Awards in the Biomedical Siences.

PURPOSE: To describe the experiences of recipients of the Burroughs Wellcome Fund's Career Awards in the Biomedical Sciences Program (CABS) and highlight selected outcomes of the award's first set of graduates. METHOD: Since 1999, all active CABS recipients have been surveyed with the goal of assessing the program's implementation and the career progress of award recipients. Data were collected on multiple variables that are indicative of establishing an independent research career (e.g., time spent on research, external grant support, and scholarly publications), along with the views of individuals about the program and how the award had affected their careers. RESULTS: As evidenced by current employment and research funding, 77% of 1995-1999 grantees had been successful in securing tenure-track faculty positions in research-intensive institutions. Of those with faculty appointments, 78% had built research programs that attracted external support. In addition, 95% credited the award with facilitating their searches for faculty jobs, 70% believed that it had shortened the time required to obtain such positions, and 82% cited the award as enhancing their ability to attract research funds. They also perceived the award as allowing them to pursue research ideas that might have been considered as risky or premature by more traditional research sponsors. CONCLUSION: The CABS program has helped participants to launch careers as active and independent investigators. Grantees also credit it with allowing them to pursue research ideas that might otherwise have been considered impractical to support.

Biological Science Disciplines↗
PubMed2004

[Reform of Japan's NTP and its technical perspectives].

The 1951 Tuberculosis Control Law of Japan is now faced with tremendous changes that have occurred during the last 50 years in tuberculosis epidemiology and in the environment in tuberculosis control implementation. The law is also challenged with the shift of the paradigm for the National Tuberculosis (TB) Programme. In order to respond properly to these changes, the Tuberculosis Panel of the Health Science Council of the Ministry of Health, Labor and Welfare submitted its report for the amendment of the law in March 2002. Based on this report, a new Tuberculosis Control Law was passed in Parliament last June, and related decrees of the Cabinet and the Ministry are now being revised in preparation for it's enactment in April 2005. In this special lecture, the main points and framework of the revisions were discussed with the perspective of the development of new technical innovations relevant to each area of the revised TB control legislation. 1. Case detection. There will be a shift from the current "indiscriminate" screening scheme to a selective one regarding periodic mass health examination. Only subjects aged 65 or older will be eligible for the screening, supplemented with selected occupational groups who are considered to be at a higher risk of TB, or may be a danger to others if they develop TB, such as health-care providers and school teachers. In addition, local autonomies are responsible for offering screening to the socio-economic high-risk populations, such as homeless people, slum residents, day laborers, and/or workers in small businesses. This means that the efforts of the autonomies are critical for the new system to be effective. The extra-ordinary examination will be limited to only the patient's contacts, and will be mandatory for those contacts so they cannot refuse to be examined by the Health Center. The public services used in the contact investigations will be greatly facilitated by such new technologies as DNA fingerprinting of TB bacilli and a new diagnostic of TB infection using whole-blood interferon-gamma determination (QuantiFERON). The quality of clinical diagnosis and monitoring of treatment should also be improved by introducing an external quality assurance system of commercial laboratory services. 2. Chemoprophylaxis. Although not explicitly defined in the new legislation, the expansion and improvement of chemoprophylaxis to cover anyone with any risk of clinical development of TB would have a tremendous effect in Japan, especially since 90% of patients who developed TB were infected tens of years ago. These technical innovations in diagnosis of TB infection will be very helpful. Development of new drug regimens for the preventive treatment is also badly needed. 3. Immunization. Prior to the amendment of the Law, the BCG vaccination of students entering primary and junior high schools has been already abandoned. In order to encourage the early primary vaccination for infants, the new Law will adopt the direct vaccination scheme in which babies will be given the BCG vaccine without tuberculin testing. This program will be implemented safely, only if it is given to young babies, e.g., less than one year old, as defined by the decree. It is essential to maintain the high level of vaccination coverage under the new program. The autonomy may encounter difficulty mobilizing client babies shortly after their birth (only one year, as compared with the current four years). To avoid the possible, though very rare, adverse health effects due to the vaccination of infected babies, careful questioning should be conducted regarding the risk of exposure to infection prior to vaccination. A ready course of treatment and examinations for abnormal reactions after vaccination (Koch's phenomenon) is also warranted. 4. Treatment and patient care: The revised Law clearly states the governmental responsibility for treating TB patients in close cooperation with a doctor. This is an important legal basis for the expansion of the DOTS Japan version. While the development of new anti-tuberculosis drugs will be realized in the near future, Japan still has to overcome the issue of improper practice of treatment, as well as the government's slow process for approving new drugs to be used for multi-drug resistant TB and non-tuberculous mycobacterioses. 5. Prefectural TB Control Plan: In order to resolve the problems specific to the respective prefectures in terms of epidemiological parameters or available resources, the new Law requests every prefecture to develop its own TB control plan. In order for the new TB Control Law to be effective, strong government commitment supported by technological innovation is mandatory. It is for that reason that the Japanese Society of Tuberculosis should aggressively join the global movement to stop TB along with the general public of Japan.

Antitubercular Agents↗
PubMed1995

The application of GIS in environmental health sciences: opportunities and limitations.

Understanding the complex spatio-temporal relationships between environmental pollution and disease and identifying exposures to environmental hazards in high-risk populations are essential elements of an effective environmental and public health management program. Modern computer technologies, such as geographic information systems (GIS), provide cost-effective tools for evaluating interventions and policies potentially affecting health outcomes. GIS analysis or display of environmental health data is also helpful in explaining disease patterns in terms of relationships with social, institutional, technological, and natural environments. This paper examines major issues related to the application of GIS in environmental health sciences. Specifically, the paper presents and discusses the basic principles, potential benefits, and major limitations of GIS in environmental health research. A real-world example application involving development and implementation of a prototype system called EMPHASIS (EnvironMental and Public Health datA analySIs System) to facilitate management, analysis, display, and presentation of environmental, socio-demographic, and health outcome data in Iowa is described. From the discussions and the example application, it is concluded that GIS can significantly add value to environmental and public health data in areas such as exploratory data analysis, hypotheses generation, confirmatory data analysis, and decision-making. The widespread adoption of GIS in these areas, however, is impeded by issues such as inconsistent spatial scales of the data, data quality and currency, lack of appropriate statistical functions for data analysis and interpretation, and data security and confidentiality.

Environmental Health↗
PubMed2005

Estimating the probability of freedom of classical swine fever virus of the East-Belgium wild-boar population.

A report of the Scientific Committee on Animal Health and Animal Welfare of the European Commission (CEC, 1999.) includes recommendations for setting up monitoring programmes for classical swine fever (CSF) infection in a wild-boar population, based on the assumption that one would detect at least 5% prevalence in a CSF-infected wild-boar population. This assumption, however, is not science based. We propose an alternative method to provide evidence for a wild-boar population being free of CSF and evaluate the efficiency of a surveillance programme that was implemented in Belgium in 1998. In our study, the probability of freedom of CSF-virus was estimated based on 789 samples; these were collected from wild-boars within the surveillance programme (within the three provinces which include 95% of the Belgian wild-boar population) and examined by three diagnostics methods (antibody detection, virus detection and virus RNA detection). A Bayesian framework was used for the estimation, accounting for the diagnostic test characteristics without the assumption of the presence of a gold standard. The median probability of freedom of CSF-virus was estimated at 0.970, with a 95% credibility interval of 0.149-1.000. Independent on the choice of the prior information, the posterior distributions for the probability of freedom of CSF-virus were always skewed close to the upper boundary of 1. This represents a big gain of knowledge since we did not use any prior information for the probability of freedom of CSF-virus and took the uncertainty about the accuracy of the diagnostic methods into account.

Animals↗
PubMedDate not supplied

Animal welfare and colony management in cancer research.

The use of animals in cancer research continues to be important for the study of tumor biology, the development and testing of new therapies, and risk assessment. The new knowledge generated from this research contributes to the health and welfare not only of human beings, but also of animals which develop cancer. However, the use of animals for cancer research is a privilege which carries with it scientific, professional, and moral obligations. The three tenets of a sound animal research program include good science, humane care, and regulatory compliance. Recognizing the complex interactions in the tumor-animal model, the investigator needs to address a wide range of issues during experimental design and implementation including animal welfare concerns, complicating factors in colony management, and compliance with laws, regulations, and policies. Therefore, both practical and philosophical considerations enjoin researchers to maintain the highest standards of animal care.

Animal Welfare↗
PubMed2002

[Knowledge management in rehabilitation--proposal for a systematic development of clinical practice guidelines].

In the past ten years, the German pension scheme has launched several initiatives that can be regarded as milestones on the way to a scientifically founded rehabilitation system. These initiatives were: the Rehab Commission (1989 - 1991), the Quality Assurance Programme (since 1994), and the German Research Funding Programme "Rehabilitation Sciences" (in cooperation with the Federal Ministry for Education and Research, since 1996). As a next step on this way, we propose an initiative aiming at a systematic development and implementation of clinical practice guidelines for the main diagnostic groups in rehabilitation. Guidelines for diagnostic and therapeutic decisions are an instrument to sift through the abundance of fast changing knowledge in medicine, to assess the existing knowledge according to its scientific evidence, and to transform it into recommendations for clinical practice. In rehabilitation, guidelines seem to be particularly needed because specialized knowledge is mostly disseminated through an informal "training on the job". Our proposal intends to establish a reference centre for each of the main indications (cardiology, musculoskeletal diseases, etc.). These centres should cooperate with experts from clinical practice and research, as well as with representatives of the cost-carrying agencies and patient organisations, and should systematically analyse the processes of rehabilitation in the most important diagnostic groups. Guided by a "process matrix of rehabilitation", these analyses should identify the points at which far-reaching decisions are called for during the processes of rehabilitation. At these points, the knowledge base available for rational decisions should be examined. When there is no sufficient scientific knowledge, consensus conferences should be organized in order to collect and assess the available expertise of practitioners and to establish guidelines for clinical practice. Since compliance with such guidelines could be easily checked in the routine quality assurance programme, this proposal seems to be a promising way of improving the knowledge base in rehabilitation in a rather short time.

Diagnosis-Related Groups↗
PubMedDate not supplied

The nuclear issue in Swedish schools.

Sweden is almost unique in that its government through its foreign office gave financial support to a carefully thought out proposal from Svenska Läkare Mot Kärnvapen (Swedish Physicians against Nuclear Weapons) for a youth education project on the nuclear issue. The Swedish Board of Education has agreed to provide: 1. In-service training for teachers on current affairs; 2. Up-to-date teaching resources and materials, such as the booklet, Facts and Reflections on Nuclear Weapons; 3. A curriculum stating that education on nuclear and other environment issues should not be a special subject but should be involved in many school activities-for example the learning of foreign languages, biology, physics, science and even physical education. The Board's recommendations have been sent to every Swedish school, together with the booklet, but each school decides for itself whether or not to implement them. However, some teachers do some education on the nuclear issue in most Swedish schools.

Adolescent↗
PubMed2000

The development of "Nutrition in Medicine" interactive CD-ROM programs for medical nutrition education.

In 1995 and in 1998 the University of North Carolina at Chapel Hill received R25 grant support to create interactive CD-ROMs for teaching nutrition and nutritional biochemistry to medical students, the Nutrition In Medicine (NIM) series. Seven of the proposed ten titles have been created. Three series (Disease, Lifecycle, and Special Topics in Nutrition) teach nutrition concepts using computer-aided instruction (CAI) with emphasis on interactive learning. Patient cases with television-quality interactive videos allow students to apply nutrition knowledge to clinical problems. Pop quizzes, text-based interactions, and multiple-choice examinations help the student self-evaluate progress via immediate feedback. Educators using the programs get instructional support and updates through a dedicated Web site, printed material, telephone support, e-mail, and CD-ROM-based computer programs. Implementation at medical and osteopathic schools is continuously surveyed through questionnaires and follow-up telephone interviews. By 1999, 120 of 137 eligible U.S. medical schools owned copies of NIM CAI programs, of which 76 indicated that they were currently implementing the programs.

CD-ROM↗
PubMed2003

Development pharmaceutics of microbicide formulations. Part II: formulation, evaluation, and challenges.

In recent years, AIDS and sexually transmitted diseases (STDs) have become a burgeoning problem and are spreading at an alarming rate. Microbicides are being developed as a new therapeutic category for prevention of transmission of sexually transmitted infections (STIs) and HIV. Many of the microbicide formulations (MF) may fail to elicit a protective response either because of a lack of efficacy or inadequate formulation. Manufacturing a stable, efficacious, safe, and optimal product is the main objective of formulation development programs. Preformulation parameters (PP), as discussed in Part I of this series, influence formulation development significantly and should be considered carefully before designing a formulation strategy. Initially, based on PP and market research, a target product profile (TPP) is generated, which defines product attributes that can be normally classified as "essential" and "desirable." A complex and dynamic process begins thereafter that takes into consideration myriad factors starting from selection of delivery system, selection of excipients, compatibility study, prototype composition, selection of process and optimization, stability testing, scale up, manufacturing under good manufacturing practices (GMP), and packaging development. Prototype formulations are evaluated for several performance characteristics (e.g., dispersion behavior, bioadhesion, retention, spreading, rheology). These compositions are also subjected to biologic evaluation by various in vitro and in vivo models. Such a well-planned, well-coordinated, and well-implemented formulation development program not only accelerates overall development but also minimizes failures in subsequent clinical development studies. The objective of this review is to highlight the importance of formulation science, outline the steps involved in this process, and explore how these can be exploited for achieving optimal MF.

Administration, Intravaginal↗
PubMedDate not supplied

Transitioning a classroom-based RN-BSN program to the Web.

Many schools of nursing are transitioning traditional and broadcast registered nurse to bachelor of science in nursing programs to the Web. A variety of options exists when placing material on the Web for nursing programs. Some challenges include having adequate numbers of faculty to implement Web-based education; student access to adequate and available computer and broadband technology; faculty readiness and development; and resources needed for a smooth transition. The authors discuss these challenges and some options for making the transition to a Web-based delivery method.

Computer Systems↗
PubMed1999

Properties of layer-by-layer vector stochastic models of force fluctuations in granular materials.

We attempt to describe the stress distributions of granular packings using lattice-based layer-by-layer stochastic models that satisfy the constraints of force and torque balance and nontensile forces at each site. The inherent asymmetry in the layer-by-layer approach appears to lead to an asymmetric force distribution, in disagreement with both experiments and general symmetry considerations. The vertical force component probability distribution is robust and in agreement with predictions of the scalar q model of Liu et al. [Science 269, 513 (1995)] and Coppersmith et al. [Phys. Rev. E 53, 4673 (1996)] while the distribution of horizontal force components is qualitatively different and depends on the details of implementation.

Journal Article↗
PubMed1986

Population strategies to enhance physical activity: the Minnesota Heart Health Program.

A population-wide, community-based program in cardiovascular disease prevention, the Minnesota Heart Health Program (MHHP), has been designed to promote more frequent and vigorous physical activity in North American communities, along with improved eating and smoking patterns. The physical activity component of this broad-based education strategy is based on the facilitation which physical activity provides to lowering of other risk characteristics for heart disease and its enhancement of other healthy behaviors and on the potential for prevention of elevated risk in the first place. The rationale for a population strategy to complement medical approaches to prevention is that exercise patterns are largely socially learned and culturally determined. The MHHP Physical Activity Program is implemented through three major education strategies: direct education, community organization, and mass communications. Early results from this 10-year project indicate that it is feasible to enter U.S. communities and to involve their leadership actively in MHHP activities of health promotion. Moreover, attitudes, knowledge, awareness, participation, and behaviors related to exercise and eating patterns appear to be changed by the program. Nevertheless, there are problems in the design, implementation, analysis and interpretation of population changes in physical activity and other health behaviors in community demonstration programs. These issues, along with their solutions, should provide useful information for medical science and for the public health about population strategies of disease prevention and health promotion.

Adolescent↗