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PubMed2004

DNA sequencing and genotyping in miniaturized electrophoresis systems.

Advances in microchannel electrophoretic separation systems for DNA analyses have had important impacts on biological and biomedical sciences, as exemplified by the successes of the Human Genome Project (HGP). As we enter a new era in genomic science, further technological innovations promise to provide other far-reaching benefits, many of which will require continual increases in sequencing and genotyping efficiency and throughput, as well as major decreases in the cost per analysis. Since the high-resolution size- and/or conformation-based electrophoretic separation of DNA is the most critical step in many genetic analyses, continual advances in the development of materials and methods for microchannel electrophoretic separations will be needed to meet the massive demand for high-quality, low-cost genomic data. In particular, the development (and commercialization) of miniaturized genotyping platforms is needed to support and enable the future breakthroughs of biomedical science. In this review, we briefly discuss the major sequencing and genotyping techniques in which high-throughput and high-resolution electrophoretic separations of DNA play a significant role. We review recent advances in the development of technology for capillary electrophoresis (CE), including capillary array electrophoresis (CAE) systems. Most of these CE/CAE innovations are equally applicable to implementation on microfabricated electrophoresis chips. Major effort is devoted to discussing various key elements needed for the development of integrated and practical microfluidic sequencing and genotyping platforms, including chip substrate selection, microchannel design and fabrication, microchannel surface modification, sample preparation, analyte detection, DNA sieving matrices, and device integration. Finally, we identify some of the remaining challenges, and some of the possible routes to further advances in high-throughput DNA sequencing and genotyping technologies.

Animals↗

PubMed1997

A Study of the Mean Field Approach to Knapsack Problems.

The mean field theory approach to knapsack problems is extended to multiple knapsacks and generalized assignment problems with Potts mean field equations governing the dynamics. Numerical tests against "state of the art" conventional algorithms shows good performance for the mean field approach. The inherently parallelism of the mean field equations makes them suitable for direct implementations in microchips. It is demonstrated numerically that the performance is essentially not affected when only a limited number of bits is used in the mean field equations. Also, a hybrid algorithm with linear programming and mean field components is showed to further improve the performance for the difficult homogeneous N x M knapsack problem. Copyright 1997 Elsevier Science Ltd. All Rights Reserved.

Journal Article↗

PubMedDate not supplied

Prevention that works for children and youth. An introduction.

The widespread implementation of effective prevention programs for children and youth is a sound investment in society's future. The most beneficial preventive interventions for young people involve coordinated, systemic efforts to enhance their social-emotional competence and health. The articles in this special issue propose standards for empirically supported programming worthy of dissemination and steps to integrate prevention science with practice. They highlight key research findings and common principles for effective programming across family, school, community, health care, and policy interventions and discuss their implications for practice. Recent advances in prevention research and growing support for evidence-based practice are encouraging developments that will increase the number of children and youth who succeed and contribute in school and life.

Adolescent↗

PubMed2003

Estimation of usual intakes: What We Eat in America-NHANES.

Usual intakes of nutrients are reliable indicators for making associations between diet and health or disease risks. Estimates of consumption of specific foods and food groups are also important for evaluating the progress in meeting key objectives in such national public health initiatives as Healthy People 2010. Reliable and valid estimates of intakes of particular foods, food ingredients, dietary supplements and other bioactive substances are also needed for dietary assessment and regulatory purposes. The ability to generate useful estimates of these constituents often requires much larger sample sizes than are needed for estimating nutrient intakes. Statistical methods recommended by the National Academy of Sciences are described that provide estimates of distributions of usual nutrient intakes and permit dietary assessment and planning at the population level. Statistical and modeling approaches for estimating intakes of foods, dietary supplements and other bioactive substances are also summarized. Based on the deliberations of discussion groups consisting of members of key stakeholder groups involved in the planning, implementation and utilization of national survey data, a high priority was placed on the need for more research to determine the best approaches for applying these methods to dietary data in the integrated What We Eat in America-National Health and Nutrition Examination Survey (NHANES).

Aged↗

PubMed2000

Can continuous quality improvement be assessed using randomized trials? [see comment].

STUDY QUESTION: Continuous quality improvement (CQI) has been implemented at least to some degree in many health care settings, yet randomized controlled trials (RCTs) of CQI are rare. We ask whether, when, and how RCTs of CQI might be designed. STUDY DESIGN: We consider two applications of CQI: as a general philosophy of management and (by analogy with the use of conceptual models from the behavioral sciences) as a conceptual model for developing specific interventions. The example of warfarin therapy for stroke prevention among patients with atrial fibrillation is used throughout. PRINCIPAL FINDINGS: While it is impractical to use RCTs to study CQI as a general management philosophy, RCT methodology is appropriate for studying CQI as a conceptual model for generating interventions. RCTs of CQI might be considered when the process change under consideration is very large, its implications (e.g., in terms of cost, outcomes of care, etc.) are very great, and the best approach is uncertain. When designing RCTs of CQI, critical decisions include (1) the unit of randomization; (2) whether the focus is on CQI as a method for generating interventions or, instead, is on specific interventions in and of themselves; and (3) the flexibility available to local personnel to modify the intervention's operational details. CONCLUSIONS: RCTs of CQI as a conceptual model for generating interventions are feasible.

Anticoagulants↗

PubMed2000

Healthy City Kwachon 21 Project: a community health promotion programme in Korea.

Disease patterns of Koreans changed from infectious disease to non-infectious disease in the 1970's. Even though there has been a need for a health promotion programme, it was hard to find the programme in the community before 1985 in Korea. In 1985, the Public Health Promotion Law was enacted and the Korean government started to encourage local government to plan and conduct community health promotion programs. Healthy City Kwachon 21 (HCK21) is a health promotion programme for all residents in Kwachon, a city which has about 70,000 population and is located adjacent to Seoul, Korea. HCK21 launched in 1998 with three guiding principles: 1) programs should be accessible to all citizens; 2) Programmes should stimulate strong community participation and 3) Programmes should change environment and society. The long term goal of HCK21 is to increase the healthy life span of citizens in Kwachon. HCK21 is a collaborative project between Kwachon and the Institute for Health Promotion of the Graduate School of Health Science and Management, Yonsei University. It has seven components: 1) Publication of Monthly Health Newsletter; 2) Smoking Cessation and Tobacco Prevention Program; 3) Community Nutrition Program; 4) Maternal and Women's Health Programme; 5) Programme for Development of District Health Management Information System; 6) Hypertension Prevention and Control Programme and 7) Physical Activity Programme. HCK21 is now being implemented in the third year program since the program conducted in 1998 and 1999 was successful with received support from the citizens. It is recommended that HCK21 be a model for an integrated community-based health promotion programme in developing countries.

Adolescent↗

PubMed2004

[Measuring the effectiveness of health promotion policy: what can be learnt from Australian success stories?].

In 1987, the Australian state of Victoria has created VicHealth, the Victorian Health Promotion Foundation, which has since been quite successful in implementing effective health promotion policies. This paper, after presenting briefly three of these success stories (tobacco control, road trauma decrease and skin cancer prevention), goes on to derive from them the essential steps of successful health promotion interventions. It concludes by reflecting on the nature of the intelligence gathering systems required to anchor good health promotion in good science, and on the barriers to proper measurement that are still pervasive.

Accidents, Traffic↗

PubMed1999

Developers and evaluation of interactive health communication applications. The Science Panel on Interactive Communications and Health.

BACKGROUND: Developers of Interactive Health Communication (IHC) are capable of providing great benefit by creating interactive programs that serve to protect and improve health. Conducting proper evaluation of these programs will ensure that they achieve these goals more successfully. CONCLUSIONS: This article seeks to inform developers of IHC about which types of evaluation are most important to include as a part of the development process and to examine the ways in which such evaluation can be implemented to benefit the producers--and ultimately, the consumers--of IHC.

Community Participation↗

PubMed2005

The role of standards in the development and implementation of clinical laboratory tests: a domestic and global perspective.

In the field of clinical laboratory medicine, standardization is aimed at increasing the trueness and reliability of measured values. Standardization relies on the use of written standards, reference measurement procedures and reference materials. These are important tools for the design and validation of new tests, and for establishing the metrological traceability of diagnostic assays. Their use supports the translation of research technologies into new diagnostic assays and leads to more rapid advances in science and medicine, as well as improvements in the quality of patient care. The various standardization tools are described, as are the procedures by which written standards, reference procedures and reference materials are developed. Recent efforts to develop standards for use in the field of molecular diagnostics are discussed. The recognition of standardization tools by the FDA and other regulatory authorities is noted as evidence of their important role in ensuring the safety and performance of in vitro diagnostic devices.

Chemistry, Clinical↗

PubMed1981

Computer-assisted instruction in a health sciences library: an experimental project.

The Leon S. McGoogan Library of Medicine at the University of Nebraska received a grant from the University of Nebraska Computer Network to study management aspects of providing computer-assisted instruction (CAI) resources. The library wished to determine: (1) faculty and student receptiveness to CAI as a library resource and (2) user response to CAI library services. A user questionnaire was designed to ascertain the appropriateness of initial management decisions regarding CAI access. The methodology employed in implementing this pilot project, the results of the questionnaire, and the future of CAI at the University of Nebraska are addressed in this paper.

Computer-Assisted Instruction↗

PubMed2003

[Radiology in managed care environment: opportunities for cost savings in an HMO].

PURPOSE: A large regional health plan in the Northeastern United States noted that its radiology costs were increasing more than it anticipated in its pricing, and noted further that other similar health plans in markets with high managed care penetration had significantly lower expenses for radiology services. This study describes the potential areas of improvement and managed care techniques that were implemented to reduce costs and reform processes. MATERIALS AND METHODS: We performed an in-depth analysis of financial data, claims logic, contracting with provider units and conducted interviews with employees, to identify potential areas of improvement and cost reduction. A detailed market analysis of the environment, competitors and vendors was accompanied by extensive literature, Internet and Medline search for comparable projects. All data were docu-mented in Microsoft Excel(R) and analyzed by non-parametric tests using SPSS(R) 8.0 (Statistical Package for the Social Sciences) for Windows(R). RESULTS: The main factors driving the cost increases in radiology were divided into those internal or external to the HMO. Among the internal factors, the claims logic was allowing overpayment due to limitations of the IT system. Risk arrangements between insurer and provider units (PU) as well as the extent of provider unit management and administration showed a significant correlation with financial performance in terms of variance from budget. Among the external factors, shared risk arrangements between HMO and provider unit were associated with more efficient radiology utilization and overall improvement in financial performance. PU with full-time management had significantly less variance from their budget than those without. Finally, physicians with imaging equipment in their offices ordered up to 4 to 5 times more imaging procedures than physicians who did not perform imaging studies themselves. CONCLUSION: We identified initiatives with estimated potential savings of approximately $ 5.5 million. Some of these initiatives are similar to the reforms to reduce cost and improve quality that are already implemented or proposed within the German healthcare system.

Budgets↗

PubMed2006

Insights into the management of emerging infections: regulating variant Creutzfeldt-Jakob disease transfusion risk in the UK and the US.

BACKGROUND: Variant Creutzfeldt-Jakob disease (vCJD) is a human prion disease caused by infection with the agent of bovine spongiform encephalopathy. After the recognition of vCJD in the UK in 1996, many nations implemented policies intended to reduce the hypothetical risk of transfusion transmission of vCJD. This was despite the fact that no cases of transfusion transmission had yet been identified. In December 2003, however, the first case of vCJD in a recipient of blood from a vCJD-infected donor was announced. The aim of this study is to ascertain and compare the factors that influenced the motivation for and the design of regulations to prevent transfusion transmission of vCJD in the UK and US prior to the recognition of this case. METHODS AND FINDINGS: A document search was conducted to identify US and UK governmental policy statements and guidance, transcripts (or minutes when transcripts were not available) of scientific advisory committee meetings, research articles, and editorials published in medical and scientific journals on the topic of vCJD and blood transfusion transmission between March 1996 and December 2003. In addition, 40 interviews were conducted with individuals familiar with the decision-making process and/or the science involved. All documents and transcripts were coded and analyzed according to the methods and principles of grounded theory. Data showed that while resulting policies were based on the available science, social and historical factors played a major role in the motivation for and the design of regulations to protect against transfusion transmission of vCJD. First, recent experience with and collective guilt resulting from the transfusion-transmitted epidemics of HIV/AIDS in both countries served as a major, historically specific impetus for such policies. This history was brought to bear both by hemophilia activists and those charged with regulating blood products in the US and UK. Second, local specificities, such as the recall of blood products for possible vCJD contamination in the UK, contributed to a greater sense of urgency and a speedier implementation of regulations in that country. Third, while the results of scientific studies played a prominent role in the construction of regulations in both nations, this role was shaped by existing social and professional networks. In the UK, early focus on a European study implicating B-lymphocytes as the carrier of prion infectivity in blood led to the introduction of a policy that requires universal leukoreduction of blood components. In the US, early focus on an American study highlighting the ability of plasma to serve as a reservoir of prion infectivity led the FDA and its advisory panel to eschew similar measures. CONCLUSIONS: The results of this study yield three important theoretical insights that pertain to the global management of emerging infectious diseases. First, because the perception and management of disease may be shaped by previous experience with disease, especially catastrophic experience, there is always the possibility for over-management of some possible routes of transmission and relative neglect of others. Second, local specificities within a given nation may influence the temporality of decision making, which in turn may influence the choice of disease management policies. Third, a preference for science-based risk management among nations will not necessarily lead to homogeneous policies. This is because the exposure to and interpretation of scientific results depends on the existing social and professional networks within a given nation. Together, these theoretical insights provide a framework for analyzing and anticipating potential conflicts in the international management of emerging infectious diseases. In addition, this study illustrates the utility of qualitative methods in investigating research questions that are difficult to assess through quantitative means.

Creutzfeldt-Jakob Syndrome↗

PubMed2002

Training costs and investment payback of implementing molecular diagnostics for identification of vancomycin resistant enterococci in a clinical microbiology laboratory.

Molecular diagnostics may be a more efficient method to manage resources; but most Microbiology laboratories have not introduced them into routine use due to the specialized training required. Using vancomycin resistant enterococci (VRE) screening during a comparison of a multiplex PCR (MPCR) and conventional biochemical testing (CBT) we studied 3 objectives: 1) to develop a molecular diagnostics in-house training program, 2) to assess the training program outcomes for competency and confidence, and 3) to determine laboratory payback. A training program for 14 technologists using multiple adult learning methods was implemented. Methods to minimize technical errors were introduced and included: use of a calibrated loop to deliver sample; prealiquotting reagents; increasing volume of specimen; addition of gel loading dye directly into reaction tubes; and establishment of an equivocal zone. In our laboratory MPCR costs $7.06 less than CBT, therefore the payback period for training and implementation would be approximately 3 years.

Cost-Benefit Analysis↗

PubMed2001

[Does knowledge hurt?].

The rate of production of medical knowledge is high and increasing, and medical practitioners find it hard to keep up. Still, production of new knowledge is normally considered to be unambiguously desirable. This paper is a philosophical reflection upon this assumption of desirability. It is noted that the health sector appears to be subject to the law of diminishing returns; this implies that more doctors and more medical technology may at some level do more harm than good. We argue that Bacon's legitimization of knowledge (knowledge is power) is less forceful in the face of biological and psychosomatic complexity. Medical research may lead to unintended harm through at least two mechanisms. First, biomedical knowledge is reified through the introduction of new medical technology whose effects are not fully known, and may lead to uncontrollable adverse effects on a clinical and societal level. Second, exaggerated attention paid to the production and implementation of biomedical factual knowledge may prevent the development and teaching of personal clinical skills, including phronesis, the individual judgemental powers that enable us to judge which goals are worth striving for, and which are not.

Humans↗

PubMed1992

Defining quality in health care.

The difficulty and importance of developing and implementing a definition of quality in health care is discussed. Some current definitions are considered, and a recommended definition of quality health care is presented.

Hospitals↗

PubMed1984

South-east Asia: curriculum guidelines for nutrition.

This project was a cooperative endeavour from its inception. It was designed for both two-way horizontal and vertical interactions at international, regional, and national levels, and within academic educational units in agriculture. This approach to introducing the study of food, nutrition and agriculture into agricultural education was made so that individuals, agencies, and groups interested or involved in agriculture, education, health, and nutrition policy or programmes in South-east Asia could have input into planning, implementing, and helping secure the study of nutrition in post-secondary agricultural curricula. It is a workable participatory model of action that has merit in other interdisciplinary educational planning endeavours.

Agriculture↗

PubMed2000

Immunization pockets of need: science and practice.

Despite high overall immunization coverage levels among U.S. preschool children, areas of underimmunization, called pockets of need, remain. These areas, which pose both a personal health and a public health risk, are typically poor, crowded, urban areas in which barriers to immunization are difficult to overcome and health care resources are limited. The purpose of this report is to review barriers to immunization of preschool children living in pockets of need and to discuss current issues in the identification of and implementation of interventions within these areas. The Centers for Disease Control and Prevention administers a federal grants program that funds state and metropolitan immunization programs. This program promotes a three-pronged approach for addressing pockets of need: (1) identification of target areas, (2) selection and implementation of programmatic strategies to improve immunization coverage, and (3) evaluation of progress or impact. At each step, scientific evidence can guide programmatic efforts. While there is evidence that state and metropolitan immunization programs are currently making efforts to address pockets of need, much work remains to be done to improve immunization coverage levels in pockets of need. Public health agencies must take on a broadened role of accountability, new partnerships must be forged, and it may be necessary to strengthen the oversight authority of public health. These tasks will require a concentration and redirection of resources to support the development of an immunization delivery infrastructure capable of ensuring the timely delivery of immunizations to the most vulnerable of America's children.

Centers for Disease Control and Prevention, U.S.↗

PubMed2002

Animal experimentation in sciences: sadistic nonsense or indispensable necessity?

The history of biomedical research clearly shows that, with exception of a very few, scientific findings could be realised only with the help of animal experiments. Unfortunately, in the past the life of animals was treated negligently and, at times, in fact criminally. Only the researchers' willingness to apply ethical principles toward laboratory animals could create a climate in which research is opening up to constructive, active animal protection and is ready to co-operate through the implementations of such programmes as the 3R-principle into daily practice. Using a number of examples, the article at hand tries to show that the dimensions concerning animal protection is very old indeed and that only a change of consciousness by the public and in research has created a situation in which a gentler treatment of life and life conditions of laboratory animals could be realised. A further development of "constructive" animal protection within the industrialised nations is only possible with this back ground. Without such a development, biomedical research is bound for deficits in one way or another. It will be loosing it's medical and economical opportunities and with it, it's meaning for man.

Animal Experimentation↗