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PubMed2004

Directed retinal nerve cell growth for use in a retinal prosthesis interface.

PURPOSE: Retinal prosthetic devices that use microelectrode arrays to stimulate retinal nerve cells may provide a viable treatment for degenerative retinal diseases. Current devices are based on electrical field-effect stimulation of remaining functional neural elements. However, the distance between target neurons and electrodes limits the potential density of electrodes and the ability to stimulate specific types of retinal neurons that contribute to visual perceptions. This study was conducted to investigate the use of microcontact printing (muCP) to direct cultured or explant retinal ganglion cell (RGC) neurites to precise and close stimulation positions and to evaluate the cell types that grow from a retinal explant. METHODS: RGCs and whole retinal explants were isolated from postnatal day-7 Sprague-Dawley rats using immunopanning purification and microdissection, respectively. Aligned muCP was used to direct the growth of RGC neurites from pure cultures (n=105) and retinal explants (n=64) along laminin patterns and to individual microelectrodes. Immunofluorescence stains (n=39) were used to determine the cell types that grew out from the retinal explants. RESULTS: RGC neurite growth was directed reproducibly along aligned laminin micropatterns to individual microelectrodes in pure RGC cultures and from full-thickness explanted rat retinas in 92% of experiments, neurites from pure RGC cultures extended along the laminin lines with an average length of 263 +/- 118 microm (SD; n=27) after 24 hours. Neurites from retinal explants extended in more than 80% of experiments and were observed to grow to an average length of 279 +/- 78 microm (n=64) after 2 days in culture. These neurites grew up to 3 mm after 1 month of culture on the laminin micropatterns. Immunohistochemical stains demonstrated that extended processes from both RGCs and glial cells grew out of retinal explants onto stamped laminin lines. CONCLUSIONS: Using muCP to pattern surfaces with growth factors, individual neuronal processes from pure RGC culture and whole retinal explants can be directed to discrete sites on a microelectronic chip surface. By directing RGC neurite processes to specific sites, single cell stimulation becomes possible. This may allow discrete populations of retinal neurons to be addressed so that physiologic retinal processing of visual information can be achieved.

Animals↗

PubMed1997

Cost-effectiveness evaluation of three approaches to case management for homeless mentally ill clients.

OBJECTIVE: In this study the authors compared the cost-effectiveness of three approaches to case management for individuals with severe mental illness who were at risk for homelessness: assertive community treatment alone, assertive community treatment with community workers, and brokered case management (purchase of services). METHOD: Individuals were randomly assigned to the three treatment conditions and followed for 18 months. Eligibility requirements included a severe DSM-III axis I diagnosis, such as schizophrenia, and either current homelessness or risk for homelessness based on prior history of homelessness. Participants were recruited from the emergency rooms and inpatient units of local psychiatric hospitals. Data on 85 people were available for analyses: 28 in assertive community treatment alone, 35 in assertive community treatment with community workers, and 22 receiving brokered case management (purchase of services). RESULTS: Clients assigned to the two assertive community treatment conditions had more contact with their treatment programs, experienced greater reductions in psychiatric symptoms, and were more satisfied with their treatment than clients in the brokered condition. There was no statistically significant difference between treatment conditions in terms of the total costs of treating the participants. However, the assertive community treatment conditions spent less money on inpatient services than brokered case management, but more on case management services and maintenance (i.e., food stamps, housing subsidies, and Supplemental Security Income payments). CONCLUSIONS: Assertive community treatment has better client outcomes at no greater cost and is, therefore, more cost-effective than brokered case management.

Adult↗

PubMed2002

Delay in diagnosis of Williams syndrome.

Williams syndrome (WS) is a well-known genetic disorder with a variable phenotype. In many cases, physical manifestations are subtle and may not be apparent at an early age, making diagnosis difficult in infants and young children who lack classic manifestations such as supravalvular aortic stenosis and hypercalcemia. Clinical suspicion is essential because the diagnostic genetic finding is not detectable on routine chromosomal analysis. Furthermore, early diagnosis allows for earlier detection and treatment of developmental, behavioral, and medical problems. In an effort to understand how and why individuals with WS are diagnosed, we conducted a survey-based study of parents of WS children. Packets containing a cover letter, consent form, parental survey and preaddressed stamped envelope were distributed to parents of children with WS. The survey included questions concerning initial diagnosis, WS findings present, medical specialists involved, and tests performed. Forty-six completed surveys were returned for analysis. The mean age at diagnosis was 3.66 years (SD 4.13). The mean age at which there were initial concerns was 0.98 year (SD 1.24) resulting in a mean delay in diagnosis of 2.77 years (SD 4.10). In addition, the involvement of a geneticists correlated with earlier diagnosis (2.26 years vs. 5.09 years without geneticist involvement, p = 0.03) and fewer tests ordered (5.2 vs. 8.2 in the nongeneticist group, p = 0.0006). We observed a significant delay in the diagnosis of WS. Of note, the involvement of a geneticist was associated with earlier diagnosis and reduced number of tests.

Adolescent↗

PubMed1994

Adult asthma assessment in an accident & emergency department.

Poor initial assessment contributes to morbidity and mortality in acute severe asthma. We have audited this aspect of management in an A & E department over a single 6-month senior house officer employment cycle. The use of a cheap and simple stamp highlighting important clinical features of asthma was associated with a significant improvement in early assessment.

Adult↗

PubMedDate not supplied

Quality of life and social environment as reported by Chinese immigrants with non-insulin-dependent diabetes mellitus.

Non-insulin-dependent diabetes mellitus (NIDDM) has been associated with stressful events such as immigration. The purpose of this paper is to report a pilot study that tested translated and back-translated instruments to ascertain factors related to diabetes management in a group of Chinese immigrants with diabetes. The descriptive, cross-sectional design included a convenience sample of 30 Chinese immigrants who had been diagnosed with NIDDM for at least 1 year. Consenting participants completed paper- and-pencil questionnaires (Diabetes Family-Behavior Checklist II, Diabetes Quality of Life, and MDRTC Knowledge Test) that had been translated and back-translated into Chinese and returned them in stamped, self-addressed envelopes. Results indicated that most of the scale and subscale reliabilities were similar to those published previously. Study participants had received limited diabetes education, reported many problems managing diabetes, especially in terms of social and vocational issues, and reported dissatisfaction with their quality of life. Diabetes-related family supportive behaviors were rated positively indicating the importance of including family members in educational programs.

Aged↗

PubMed1988

A benefit-cost analysis of family planning services in Iowa.

An analysis of publicly funded family planning services in Iowa was undertaken to provide tangible estimates based on local data of the value of these services in averting unplanned and unwanted births to women who voluntarily use them. The study reports methods that can be applied by other states in evaluating their own family planning programs. Benefits were measured as the cost savings in public expenditures avoided by providing family planning services to low- and marginal-income women. Iowa data for AFDC, food stamps, and Medicaid payments were used to calculate benefits. The total benefit savings were adjusted to reflect the impact of family planning services on preventing births. The adjusted savings were accrued over one-year and five-year time frames and for four age groups (14-19, 20-29, 30-34, and 35-44). In the base year, the cost of providing family planning services in Iowa to the more than 56,000 women who used them was $3.1 million, or $59 per user. Results showed that the benefits of family planning services were highest for teenagers who would become eligible for public assistance programs upon the birth of a child.

Adolescent↗

PubMed1997

An evaluation of the Alexander Technique for the management of disability in Parkinson's disease--a preliminary study.

OBJECTIVE: To test the effect of the Alexander Technique (AT) on the management of disability and feelings of depression in patients with Parkinson's disease (PD). DESIGN: Subjects completed four self-report questionnaires, one set before the course of lessons and a repeat set when the lessons were ended. The postal questionnaires were mailed directly to the subject's home from the university with a stamped addressed envelope. SUBJECTS: Seven volunteers, with no previous experience of the Alexander Technique, diagnosed by consultant neurologists to have idiopathic Parkinson's disease. SETTING: The subjects were contacted by the nearest registered AT teacher and were taught in the individual teacher's practice rooms, in the same way as other pupils. INTERVENTIONS: Subjects received a median of 12 lessons. MAIN OUTCOME MEASURES: The self-report measures were the BECK Depression Inventory, activities in daily living, body concept, and social functioning disability questionnaires. RESULTS: Post-lessons the subjects were significantly (p < 0.05) less depressed. They had a significantly more positive body concept and had significantly less difficulty in performing daily activities, and significantly less difficulty on the fine movement and gross movement subscales of the activities in daily living questionnaire. CONCLUSIONS: The statistically significant results are consistent with the hypothesis that for PD patients on drug therapy, the Alexander Technique reduces depression and improves the management of disability, but in the absence of a control group and a larger sample, they cannot be said to confirm the hypothesis. The likelihood of the AT being effective in the management of disability for many PD patients, as shown in this study, makes further controlled research desirable.

Aged↗

PubMed2006

An introductory guide to survey research in anaesthesia.

Surveys allow convenient and inexpensive research. Surveys include mail-out questionnaires, email questionnaires, telephone interviews, and personal interviews. Despite a widespread perception that surveys are easy to conduct, good surveys need rigorous design, implementation and analysis. This requires substantial planning, time and effort. The most important step in designing a survey is to clearly define the question(s) the survey aims to answer The target population, measured variables and types of associations being investigated should be specific and unambiguous. Investigators should concentrate on what they 'need to know' rather than what would be 'nice to know'. During development surveys should be piloted to identify problems. The main goal when implementing a survey is to maximize the response rate to avoid misleading results. Evidence-based strategies, including brief personalized surveys with stamped return envelopes, can be used to maximize the response rate. A poorly conducted survey can lead to misleading or invalid conclusions and may undermine participation in subsequent surveys by the target population.

Anesthesiology↗

PubMed1980

Name and identity.

Identity, though complex, can be encoded in a name. The name bears the stamp of the namers' traditions and their hopes for the child. The infant's characteristics influence the choice to some degree and, to a degree, a name affects the person who bears it. The interface between names and personal identity is illustrated clinically in syndromes of transsexualism and multiple personality, in twinning, and in the development of the ego-ideal.

Black or African American↗

PubMed1986

Regional Review Boards of Ontario: a medico-legal review.

The functioning of the Regional Review Boards of Ontario (RRB) or their equivalents in other provinces has not been previously reviewed. This study reviews socio-demographic and clinical data of 248 patients seen between 1974 and 1983 by the RRB. The RRB heard 132 applications as 116 were withdrawn. The results are compared with 173 matched inpatient controls. Applications by psychiatrists were infrequently withdrawn or revoked. Long delays between the time of application and the hearing, and a trend towards increasing numbers of applications were noted. Schizophrenia and affective disorder were the most prevalent diagnosis with alcohol abuse and organic brain syndrome being less common among applicants. An increase in duration of stay and transfer to chronic care institutions were found among applicants. Results suggest that RRB's are not 'rubber stamping bodies' and should be more readily available and should have increased public accountability. Future changes to the Mental Health Act should be based on scientific data.

Commitment of Persons with Psychiatric Disorders↗

PubMedDate not supplied

Shelter environment and placement in community affects lifestyle factors among homeless families in Minnesota.

PURPOSE: To investigate the impact of the shelter environment and surrounding community on lifestyle factors influencing the health of homeless families. DESIGN AND SETTING: Seven focus groups were conducted at two homeless shelters serving families in Minneapolis, Minnesota. Food resources and food prices at convenience stores were recorded within a five-block radius of shelters. SUBJECTS: Low-income parents of children aged 3-12 years (n = 53). MEASURES: Focus groups were transcribed verbatim, evaluated for common themes, coded, and reevaluated for consistency. Food resources were mapped via GIS software, and recorded food prices were compared to available TFP market basket prices. ANALYSIS RESULTS: The shelter environment and surrounding community influenced lifestyle factors related to health, including food access and availability, exercise behaviors, job access, and day care issues. Participants commented that location of grocery stores, inflated prices, and poor food quality and variety limited their families' food choice and access. Walking was the main form of exercise and served as a means of transportation. Finding employment, housing, and affordable day care caused high levels of stress because of inadequate social support and government subsidies. CONCLUSIONS: Several strategies should be considered to modify environments affecting lifestyle factors among homeless families, including greater affordability and access of food, reevaluation of food stamp allotments, alterations in urban planning designs, and increased access to affordable day care.

Adult↗

PubMed2005

Prospective study of black-white differences in food insufficiency among homebound elders.

OBJECTIVE: This study examines race differences in the association of sociodemographic and health-related characteristics with change in food sufficiency status over 1 year in homebound older adults. METHOD: Using sociodemographic and health-related data collected during two in-home assessments as part of the North Carolina Nutrition and Function Study, logistic regression models (binary and nominal outcomes) adjusted for covariates and examined the characteristics associated with 1-year change in risk (RFI) and presence (FI) of food insufficiency among a random sample of 268 home-delivered meals participants. RESULTS: Not having enough money for food and having to prepare cheaper and smaller meals was associated with increased RFI and FI at 1 year; having to borrow money for food, loss of food stamps, and inadequate income increased the odds among Whites, and increased medication use among Blacks. DISCUSSION: The findings suggest that race, independent of other characteristics, is associated with diminished food sufficiency over 1 year.

Aged↗

PubMed1988

Consumer preferences for verbal and written medication information.

The extent of medication use and drug information preferences was surveyed randomly from patients at six different pharmacy health care systems. Following verbal consultation, each patient was given one or more modified United States Pharmacopoeia drug information leaflets corresponding to the verbal information and a self-addressed, stamped questionnaire to complete. Chi-square analysis was performed on 317 responses with overwhelming acceptance (96 percent) of the medication information provided. Although a majority of respondents (62 percent) preferred a combination of both written and oral information, specific information preferences (oral, written, or both) were significantly related to educational level, pharmacy attended, and prescription status. Nearly 45 percent of the respondents indicated the information was responsible for changing their medication use. Subjects who were elderly, taking cardiovascular medications, or getting refill prescriptions were significantly less likely to change as a result of the information provided. Although 65 percent of the respondents were unwilling to pay an additional fee for the service, females and those who were 45-54 years and over 65 years old were significantly more willing to pay for the information. In addition, the willingness to pay tended to increase as the number of daily medications taken increased. Consideration of socioeconomic and prescription variables may help define subgroups with specific information preferences and counseling activities that may be directly reimbursable.

Adolescent↗

PubMedDate not supplied

A systems-based intervention to promote smoking as a vital sign in patients served by community health centers.

The frequency of asking and advising adult patients about tobacco use was measured after an intervention to adopt smoking as a vital sign at 7 community health centers. The intervention consisted of training staff, revising forms and vital sign stamps, and disseminating educational materials. Documentation in medical charts was reviewed for 1,571 randomly sampled patients in 2002 and 2003. The point prevalence (last encounter) and period prevalence (any annual encounter) of asking patients about smoking increased significantly from 2002 to 2003 (59% to 85%, and 71% to 97%, respectively) overall and at each health center. On advising smokers to quit, 4 health centers improved, but the overall point prevalence, 26%, and period prevalence, 46%, were unchanged over time. An intervention using multiple strategies may have contributed to improving the rates of asking but did not have as large or consistent an impact on rates of advising smokers to quit.

Adolescent↗

PubMed2002

Children in the Oregon Health Plan: how have they fared?

This study examines the impact of the Oregon Health Plan (OHP) on children's access to care. A telephone survey was conducted in 1998 of two groups of children: OHP enrollees and food stamp recipients not enrolled in OHP. Much of OHP's impact has been realized by the simple extension of health insurance coverage to Oregon's low-income children. The availability of insurance significantly increased the use of physician visits and dental care. The priority list had little effect on children, affecting only 2 percent of OHP children surveyed, most of whom succeeded in getting the service anyway. Thus, despite the negative publicity prior to its implementation, there is no evidence that "rationing" under OHP has substantially restricted access to needed services for children.

Aid to Families with Dependent Children↗

PubMed2003

OXBench: a benchmark for evaluation of protein multiple sequence alignment accuracy.

BACKGROUND: The alignment of two or more protein sequences provides a powerful guide in the prediction of the protein structure and in identifying key functional residues, however, the utility of any prediction is completely dependent on the accuracy of the alignment. In this paper we describe a suite of reference alignments derived from the comparison of protein three-dimensional structures together with evaluation measures and software that allow automatically generated alignments to be benchmarked. We test the OXBench benchmark suite on alignments generated by the AMPS multiple alignment method, then apply the suite to compare eight different multiple alignment algorithms. The benchmark shows the current state-of-the art for alignment accuracy and provides a baseline against which new alignment algorithms may be judged. RESULTS: The simple hierarchical multiple alignment algorithm, AMPS, performed as well as or better than more modern methods such as CLUSTALW once the PAM250 pair-score matrix was replaced by a BLOSUM series matrix. AMPS gave an accuracy in Structurally Conserved Regions (SCRs) of 89.9% over a set of 672 alignments. The T-COFFEE method on a data set of families with <8 sequences gave 91.4% accuracy, significantly better than CLUSTALW (88.9%) and all other methods considered here. The complete suite is available from http://www.compbio.dundee.ac.uk. CONCLUSIONS: The OXBench suite of reference alignments, evaluation software and results database provide a convenient method to assess progress in sequence alignment techniques. Evaluation measures that were dependent on comparison to a reference alignment were found to give good discrimination between methods. The STAMP Sc Score which is independent of a reference alignment also gave good discrimination. Application of OXBench in this paper shows that with the exception of T-COFFEE, the majority of the improvement in alignment accuracy seen since 1985 stems from improved pair-score matrices rather than algorithmic refinements. The maximum theoretical alignment accuracy obtained by pooling results over all methods was 94.5% with 52.5% accuracy for alignments in the 0-10 percentage identity range. This suggests that further improvements in accuracy will be possible in the future.

Amino Acid Sequence↗

PubMed2004

PASS2: an automated database of protein alignments organised as structural superfamilies.

BACKGROUND: The functional selection and three-dimensional structural constraints of proteins in nature often relates to the retention of significant sequence similarity between proteins of similar fold and function despite poor sequence identity. Organization of structure-based sequence alignments for distantly related proteins, provides a map of the conserved and critical regions of the protein universe that is useful for the analysis of folding principles, for the evolutionary unification of protein families and for maximizing the information return from experimental structure determination. The Protein Alignment organised as Structural Superfamily (PASS2) database represents continuously updated, structural alignments for evolutionary related, sequentially distant proteins. DESCRIPTION: An automated and updated version of PASS2 is, in direct correspondence with SCOP 1.63, consisting of sequences having identity below 40% among themselves. Protein domains have been grouped into 628 multi-member superfamilies and 566 single member superfamilies. Structure-based sequence alignments for the superfamilies have been obtained using COMPARER, while initial equivalencies have been derived from a preliminary superposition using LSQMAN or STAMP 4.0. The final sequence alignments have been annotated for structural features using JOY4.0. The database is supplemented with sequence relatives belonging to different genomes, conserved spatially interacting and structural motifs, probabilistic hidden markov models of superfamilies based on the alignments and useful links to other databases. Probabilistic models and sensitive position specific profiles obtained from reliable superfamily alignments aid annotation of remote homologues and are useful tools in structural and functional genomics. PASS2 presents the phylogeny of its members both based on sequence and structural dissimilarities. Clustering of members allows us to understand diversification of the family members. The search engine has been improved for simpler browsing of the database. CONCLUSIONS: The database resolves alignments among the structural domains consisting of evolutionarily diverged set of sequences. Availability of reliable sequence alignments of distantly related proteins despite poor sequence identity and single-member superfamilies permit better sampling of structures in libraries for fold recognition of new sequences and for the understanding of protein structure-function relationships of individual superfamilies. PASS2 is accessible at http://www.ncbs.res.in/~faculty/mini/campass/pass2.html

Amino Acid Sequence↗

PubMed2005

Socioeconomic factors and adolescent pregnancy outcomes: distinctions between neonatal and post-neonatal deaths?

BACKGROUND: Young maternal age has long been associated with higher infant mortality rates, but the role of socioeconomic factors in this association has been controversial. We sought to investigate the relationships between infant mortality (distinguishing neonatal from post-neonatal deaths), socioeconomic status and maternal age in a large, retrospective cohort study. METHODS: We conducted a population-based cohort study using linked birth-death certificate data for Missouri residents during 1997-1999. Infant mortality rates for all singleton births to adolescent women (12-17 years, n = 10,131; 18-19 years, n = 18,954) were compared to those for older women (20-35 years, n = 28,899). Logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for all potential associations. RESULTS: The risk of infant (OR 1.95, CI 1.54-2.48), neonatal (1.69, 1.24-2.31) and post-neonatal mortality (2.47, 1.70-3.59) were significantly higher for younger adolescent (12-17 years) than older (20-34 years) mothers. After adjusting for race, marital status, age-appropriate education level, parity, smoking status, prenatal care utilization, and poverty status (indicated by participation in WIC, food stamps or Medicaid), the risk of post-neonatal mortality (1.73, 1.14-2.64) but not neonatal mortality (1.43, 0.98-2.08) remained significant for younger adolescent mothers. There were no differences in neonatal or post-neonatal mortality risks for older adolescent (18-19 years) mothers. CONCLUSION: Socioeconomic factors may largely explain the increased neonatal mortality risk among younger adolescent mothers but not the increase in post-neonatal mortality risk.

Adolescent↗