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Physical activity and sports-recreation experiences play an important part in the psychosomatic development of the multihandicapped. The importance of treating the multihandicapped individual as a whole and not keeping the motoric handicap in isolation is pointed out. Based on a theoretical framework for physical activity and sports programs, the complexity of issues in assessment, sports program design and sports competition is discussed. Some 200 multihandicapped individuals are assessed in their various ability levels and place into respective ability groups prior to the events. The competition events consist of track and field activities as well as a swimming event. The competition is open to manual as well as electric (12V; 24V) wheelchairs, respectively. Assessment procedures and results are described in detail for the track and field events. Assessment and participation in the swim event require the individual to swim a distance of 25 yards in two separate ability groups, 1) with adaptive floatation and, 2) without the aid. The sport events are organized for public school application as well as institutional settings without the need for a great amount of equipment. In designing programs and facilities to accommodate sports programs it is important to design for the functioning of the individual and not in such a way as to force the individual to function within the limits of the program design. If we are to make the multihandicapped comfortable in the mainstream of everyday life, it is the sports and recreation leader's responsibility to asses and present activities that aid in constantly excelling in physical and emotional development.
The objectives of toxicokinetic (TK) studies are to evaluate systemic exposure of the toxicity species to drug and/or metabolite(s) and to relate exposure to dose level and toxicological findings. The tacit assumption is that such exposure can be related to target organ toxicity. Planning a TK program involves early development (often during discovery support) of an appropriate plasma assay, assurance that the studies conform to Good Laboratory Practices, evaluating exposure at steady state, and effective collaboration among toxicologists, kineticists, and other relevant disciplines. The 3 types of TK studies--prospective, concomitant, and retrospective--each have different goals. The various stages of TK program implementation range from those during drug discovery and selection to support of chronic toxicity studies. Exposure is best expressed as the area under the plasma concentration/time curve of drug and/or metabolite(s) and, for highly protein bound drugs, is based on the unbound fraction. Although the objectives of TK programs are generally standard and the Second International Conference on Harmonization has developed TK guidelines, the programs differ among pharmaceutical companies. Some variables in program design and implementation include properties of the drug, formulation used, characteristics of the target species, ability to develop a toxicokinetic-toxicodynamic relationship, strategies based on scientific/technical/philosophical considerations, dedicated resources, corporate support, and effectiveness of interdepartmental collaborations.
Long life expectancy, demand for high activity levels, and bone loss at the time of revision motivate the search for reliable and successful noncemented hip stem designs. It is hypothesized that improved implant fit may increase the longevity of noncemented total joints. Quantitative X-ray CT has enabled the use of a computerized stem design program, which designs an optimal-fit hip stem for individual femurs. Computed tomography and interactive image processing methods are used to generate the individual three-dimensional femoral models, which are used by the stem design program. Optimal-fit design provides maximum stem-bone contact while satisfying the requirement of being surgically insertable. Previous methods of custom implant design, including those that use three-dimensional CT modeling, have not provided optimal stem-bone fit. Quantitative results of this new process are presented.
Program design for training in Adolescent Medicine is still in an evolutionary state. Postgraduate fellows and program directors have different perceptions with regard to the importance of various components of the ideal training program. Fellows indicate a higher priority for problems associated with the female reproductive system than do their mentors. Inpatient experience received lesser emphasis by the Fellows. Adolescent Medicine as a subspecialty discipline is discouraged.
Two programs, OVID and SUPER, for exploring the similarity of molecules with respect to their action at a receptor are described. OVID accepts two molecules as input and optimizes the three-dimensional overlap of specified atoms in one molecule with specified atoms in the second molecule. The result is expressed as a percent of the theoretical maximum. OVID gives a quantitative measure of the extent of a guessed correspondence between two molecules based on volume overlap of selected atoms. The Achilles' heel of OVID is that the correspondence between the two molecules has to be guessed. We realized that it would be better to systematically examine all possible correspondences of two structures to minimize the chance of overlooking a superior correspondence. We created SUPER to satisfy this need. SUPER accepts two molecules as input and finds the top twenty correspondences of their surfaces and charge distributions, giving a quantitative measure of the extent of each correspondence. An instructive example of the application of OVID and SUPER to the design of leukotriene D4 receptor antagonists is described. SUPER appears to be a practical brain-storming tool for the medicinal chemist trying to understand how molecules whose structures may not resemble one another in an obvious way can bind to the same site.
The Minnesota Heart Health Program (MHHP) is a community-based research and demonstration program designed to accelerate population-wide changes in coronary risk factors and disease. MHHP is on-going in three pairs of communities in Minnesota, North and South Dakota. To strengthen inference of program effects, its basic design involves elements of control, repetition, sensitive trend measurements and evaluation of the effects of program components. Its evaluation design is presented here as a comprehensive measurement system for disease endpoints, risk factor levels and efficacy of specific educational programs. The MHHP design is able to compare risk factor levels and mortality rates between education and comparison communities. MHHP statistical power is sufficient to detect community-wide changes of public health import. Early results show comparability of education and comparison communities for most variables. Widespread community awareness of and participation in MHHP programs is reported.
The concept of object-oriented design and programming has recently received a great deal of attention from the software engineering community. This paper highlights the realisable benefits of using the object-oriented approach in the design and development of clinical decision support systems. These systems seek to build a computational model of some problem domain and therefore tend to be exploratory in nature. Conventional procedural design techniques do not support either the process of model building or rapid prototyping. The central concepts of the object-oriented paradigm are introduced, namely encapsulation, inheritance and polymorphism, and their use illustrated in a case study, taken from the domain of breast histopathology. In particular, the dual roles of inheritance in object-oriented programming are examined, i.e., inheritance as a conceptual modelling tool and inheritance as a code reuse mechanism. It is argued that the use of the former is not entirely intuitive and may be difficult to incorporate into the design process. However, inheritance as a means of optimising code reuse offers substantial technical benefits.
Actual use of a newly established geriatric clinic in a low-cost housing unit was appreciably below projected numbers, even though cost and transportation were removed as barriers to care. In a survey of building occupants, 20% were unaware of the clinic's existence. More than 90% of the occupants did not know clinic hours but a third could identify clinic staff. About half of the occupants had used the clinic, often for minor services. The major reason for lack of use of the clinic was an established pattern of receiving medical care which occupants were reluctant to risk or abandon. Needs must be appropriately assessed before service programs are designed for the elderly. Assumptions may at times be incorrect. A thorough understanding of needs and existing methods of meeting them leads to more appropriately designed programs.
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The Mayo Three-Community Hypertension Control Program implemented graduated programs for the control of high blood pressure in three rural southeastern Minnesota communities, beginning in 1974. Prevalence of hypertension (when defined as diastolic blood pressure, at initial screening, of 95 mm Hg or more) was similar to that found for comparable groups by age and sex in the United States generally, but an atypically high frequency of known but untreated hypertension was found. Programs of public and professional information, systematic household screening, continuing professional education (two communities), and a new community hypertension clinic (one community) were initiated, and plans were made to evaluate the programs simultaneously by means of total rescreening of persons found to be hypertensive initially. The present report describes in detail the design of the program and the results of initial screening in relation to findings in other populations at the time. Subsequent reports assess the impact of each program on its target community and of a community hypertension clinic within the one setting where this component of a model program was established.
Designated or directed blood transfusion (DD) is a controversial practice; its merits are currently debated on the basis of implications for the national blood supply and on the "safety" of directed blood compared with homologous blood. An equally compelling issue for the merits of DD is whether this practice results in its putative effect: to avoid volunteer homologous blood exposure. To study this, the authors reviewed 112 consecutive patients (73 orthopedic) who predeposited autologous blood for elective surgery. This group was compared with 17 patients (all orthopedic) who predeposited autologous blood and also requested storage of designated blood. Seven of 17 patients with DD subsequently received homologous blood, compared with 11 of 112 patients without designated blood (NDD, P less than 0.01) and 3 of 35 NDD orthopedic patients asked to predonate three or more units of blood, P = 0.015. DD and NDD patients were no different when analyzed for age, sex, or units blood stored; admission, nadir, or discharge hematocrit; autologous blood transfused; days in hospital; or surgical blood loss. The authors conclude that patient requests for DD are unjustified for elective surgical patients who are eligible to donate autologous blood because DD as practiced in this setting does not avoid subsequent homologous blood exposure. Maximizing autologous blood procurement is the preferred alternative for avoiding homologous blood transfusion.
This study compared differences in role orientation and role deprivation between 41 LPN-transition students and 123 basic traditional associate degree nursing (ADN) students upon entry and exit to a specially designed ADN program. The Corwin Role Conception Scale was used to assess role conception and deprivation. Statistically significant differences were noted upon entry between LPN-transition students and traditional ADN students in professional and service role conceptions and in role deprivation, upon exit in professional role conception and role deprivation between LPN-transition and traditional ADN students, and in professional role conception within the LPN-transition students. No differences were found within traditional ADN students from entry to exit of the program.
We have developed a computer program, DESIGN, for optimization of ligand binding experiments to minimize the "average" uncertainty in all unknown parameters. An earlier report [G. E. Rovati, D. Rodbard, and P. J. Munson (1988) Anal. Biochem. 174, 636-649] described the application of this program to experiments involving a single homologous or heterologous dose-response curve. We now present several advanced features of the program DESIGN, including simultaneous optimization of two or more binding competition curves optimization of a "multiligand" experiment. Multiligand designs are those which use combinations of two (or more) ligands in each reaction tube. Such designs are an important and natural extension of the popular method of "blocking experiments" where an additional ligand is used to suppress one or more classes of sites. Extending the idea of a dose-response curve, the most general multiligand design would result in a "dose-response surface". One can now optimize the design not only for a single binding curve, but also for families of curves and for binding surfaces. The examples presented in this report further demonstrate the power and utility of the program DESIGN and the nature of D-optimal designs in the context of more complex binding experiments. We illustrate D-optimal designs involving one radioligand and two unlabeled ligands; we consider one example of homogeneous and several examples of heterogeneous binding sites. Further, to demonstrate the virtues of the dose-response surface experiment, we have compared the optimal surface design to the equivalent design restricted to traditional dose-response curves. The use of DESIGN in conjunction with multiligand experiments can improve the efficiency of estimation of the binding parameters, potentially resulting in reduction of the number of observations needed to obtain a desired degree of precision in representative cases.
A computer program (PINCERS) is described for use in the design of synthetic genes and mixed-probe DNA sequences. A protein sequence is reverse translated with generation of synonymous codons at each position producing a degenerate sequence. In order to locate potential restriction enzyme sites, the degenerate sequence is searched with a library of restriction enzymes for sites that utilize any combination of synonymous codons. These sites are indicated in a map so that they may be incorporated into the synthetic gene sequence. The program allows the user to select the appropriate codon usage table for the organism of interest and then to set a threshold usage frequency below which codons are not generated. PINCERS may also be used to assist in planning the synthesis of mixed-probe DNA sequences for cross-hybridization experiments. It can identify regions of specified length with the protein sequence that have the least overall degeneracy, thereby minimizing the number of probes to be synthesized and, therefore, maximizing the concentration of a given probe sequence.
Although many dental hygienists have considered pursuing a baccalaureate degree, many barriers intervene to prevent accomplishment of this goal. The external degree is one option that could be available to overcome some of the barriers to accessibility. An external program is one that makes education accessible to students in nontraditional ways. A characteristic of these programs is that students can usually pursue academic credit toward a degree without being physically present on the degree-granting campus for the majority of the program. This paper reports the results of a 1988 survey of certificate and associate degree dental hygienists' interest in an external baccalaureate degree completion program. A questionnaire was mailed to 213 certificate and associate degree dental hygienists in Tennessee who had expressed an interest in degree completion. Two hundred six questionnaires were returned for a response rate of 96.7%. In order to determine the potential success of such programs, the following factors were explored: the motivations or reasons for participating; program design factors that might encourage or deter participation; degree of employer support; and individual characteristics relevant to participation, such as personal commitment and demographic information. Geographic location, flexibility in scheduling, and accessibility to course work were the program design factors most important to the likely participants. Likely participants indicated that they wanted to return to complete their baccalaureate degrees for personal satisfaction, for the status of the degree, and to increase their knowledge and skill in dental hygiene. They indicated that they did not want to change the focus of their careers. The area of study rated as most important was advanced clinical dental hygiene. The likely participants were found to resemble other nontraditional students. They averaged 34 years of age, were married with children living at home, and were able to study on a part-time basis only. The analysis of the data obtained from the questionnaire led to the conclusion that external program design factors would be essential for most certificate and associate degree dental hygienists to participate in a baccalaureate degree completion program.