The Indian Health Service Planning Process, An Indepth Study and Evaluation

This report is an evaluation of the Indian Health Service (IHS) in the Pacific Northwest Region. The purpose of the study was to evaluate the health care planning process of the IHS. This primary goal was expanded through the articulation of three objectives. The first was to assess evidence of real and on-going planning within IHS. The second was to identify the actual or expressed purposes of the plans. The third was to identify the discrepancies between actual IHS plans and a standardized comprehensive model. The methodology used in completing this evaluation comprised three major procedural steps. The first was the formulation of a standardized and comprehensive model for health care planning. The second was an analysis of the existing system of health care planning used at the three administrative units of IHS. The third was a definition and evaluation of the IHS planning process. For the first step, a generic model was developed to provide a baseline for evaluating the wide variety of planning strategies employed by the IHS. The second step required field work and on-site visits at all Portland Area Service Units. The interviews with local Service Unit administrators aided the evaluators in their assessment of the process of defining and implementing specific health care goals and objectives. The third step involved an evaluation of the actual IHS planning process by comparing the ideal model and the realities of implementation.This report finds that: 1) the IHS planning process is directly linked to predetermined funding levels, which severely limits planing objectivity; 2) the IHS planning process is ill-defined and fails to demonstrate whether or not the health status of the Northwest Indians is being upgraded; 3) IHS planning is oriented to identify symptoms rather that causes, and is based on treatment rather than prevention at the level of the individual or total population; 4) the existing data system is geared to providing top level monitoring and provides little useful data for Tribal long-range planning; and 5) consumer input into the planning process is limited due to a lack of consumer knowledge and ability to fully and actively participate in the process.The study recommendations were presented in five parts: 1) IHS should structure their planning process to reflect a problem solving approach; 2) there should be a concerted effort to establish a standard pattern for demographic enumeration; 3) IHS should develop a system and open lines of communication for active consumer participation in the health care planning process; 4) IHS must begin to address structural flaws in the total organization including manpower levels and expertise, and control over lines of communication; and 5) IHS should initiate a major policy review to address the weaknesses inherent in short-range resource allocations

Unpacking the relationships between impulsivity, neighborhood disadvantage, and adolescent violence : an application of a neighborhood-based group decomposition

The research leading to these results has received funding from the European Research Council under the European Union’s Seventh Framework Programme (FP/2007–2013)/ERC Grant Agreement no. 615159 (ERC Consolidator Grant DEPRIVEDHOODS, Socio-spatial inequality, deprived neighbourhoods, and neighbourhood effects); and from the Marie Curie programme under the European Union’s Seventh Framework Programme (FP/2007–2013)/Career Integration Grant no. PCIG10-GA-2011-303728 (CIG Grant NBHCHOICE, Neighbourhood choice, neighbourhood sorting, and neighbourhood effects).Scholars have become increasingly interested in how social environments condition the relationships between individual risk-factors and adolescent behavior. An appreciable portion of this literature is concerned with the relationship between impulsivity and delinquency across neighborhood settings. The present article builds upon this growing body of research by considering the more nuanced pathways through which neighborhood disadvantage shapes the development of impulsivity and provides a situational context for impulsive tendencies to manifest in violent and aggressive behaviors. Using a sample of 12,935 adolescent from the National Longitudinal Study of Adolescent to Adult Health (Add Health) (mean age = 15.3, 51% female; 20% Black, 17% Hispanic), we demonstrate the extent to which variation in the association between impulsivity and delinquency across neighborhoods can be attributed to (1) differences in mean-levels of impulsivity and violence and (2) differences in coefficients across neighborhoods. The results of a series of multivariate regression models indicate that impulsivity is positively associated with self-reported violence, and that this relationship is strongest among youth living in disadvantaged neighborhoods. The moderating effect of neighborhood disadvantage can be attributed primarily to the stronger effect of impulsivity on violence in these areas, while differences in average levels of violence and impulsivity account for a smaller, yet nontrivial portion of the observed relationship. These results indicate that the differential effect of impulsivity on violence can be attributed to both developmental processes that lead to the greater concentration of violent and impulsive adolescents in economically deprived neighborhoods as well as the greater likelihood of impulsive adolescents engaging in violence when they reside in economically disadvantaged communities.Publisher PDFPeer reviewe

Analysis of vaginal microbicide film hydration kinetics by quantitative imaging refractometry

We have developed a quantitative imaging refractometry technique, based on holographic phase microscopy, as a tool for investigating microscopic structural changes in water-soluble polymeric materials. Here we apply the approach to analyze the structural degradation of vaginal topical microbicide films due to water uptake. We implemented transmission imaging of 1-mm diameter film samples loaded into a flow chamber with a 1.5×2 mm field of view. After water was flooded into the chamber, interference images were captured and analyzed to obtain high resolution maps of the local refractive index and subsequently the volume fraction and mass density of film material at each spatial location. Here, we compare the hydration dynamics of a panel of films with varying thicknesses and polymer compositions, demonstrating that quantitative imaging refractometry can be an effective tool for evaluating and characterizing the performance of candidate microbicide film designs for anti-HIV drug delivery. © 2014 Rinehart et al

Detailed Regulatory Mechanism of the Interaction between ZO-1 PDZ2 and Connexin43 Revealed by MD Simulations

The gap junction protein connexin43 (Cx43) binds to the second PDZ domain of Zonula occludens-1 (ZO-1) through its C-terminal tail, mediating the regulation of gap junction plaque size and dynamics. Biochemical study demonstrated that the very C-terminal 12 residues of Cx43 are necessary and sufficient for ZO-1 PDZ2 binding and phosphorylation at residues Ser (-9) and Ser (-10) of the peptide can disrupt the association. However, only a crystal structure of ZO-1 PDZ2 in complex with a shorter 9 aa peptide of connexin43 was solved experimentally. Here, the interactions between ZO-1 PDZ2 and the short, long and phosphorylated Cx43 peptides were studied using molecular dynamics (MD) simulations and free energy calculation. The short peptide bound to PDZ2 exhibits large structural variations, while the extension of three upstream residues stabilizes the peptide conformation and enhanced the interaction. Phosphorylation at Ser(-9) significantly weakens the binding and results in conformational flexibility of the peptide. Glu210 of ZO-1 PDZ2 was found to be a key regulatory point in Cx43 binding and phosphorylation induced dissociation

Controlling photons using electromagnetically induced transparency

It is well known that a dielectric medium can be used to manipulate properties of light pulses. However, optical absorption limits the extent of possible control: this is especially important for weak light pulses. Absorption in an opaque medium can be eliminated via quantum mechanical interference, an effect known as electromagnetically induced transparency. Theoretical and experimental work has demonstrated that this phenomenon can be used to slow down light pulses dramatically, or even bring them to a complete halt. Interactions between photons in such an atomic medium can be many orders of magnitude stronger than in conventional optical materials

Clinical ethics revisited

A decade ago, we reviewed the field of clinical ethics; assessed its progress in research, education, and ethics committees and consultation; and made predictions about the future of the field. In this article, we revisit clinical ethics to examine our earlier observations, highlight key developments, and discuss remaining challenges for clinical ethics, including the need to develop a global perspective on clinical ethics problems

Whole exome sequencing coupled with unbiased functional analysis reveals new Hirschsprung disease genes

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Topical microbicides to prevent the transmission of HIV: formulation gaps and challenges

The efforts of the topical microbicide field to identify a safe and effective topical microbicide were realized in July of 2010 with the reporting of the results of the Centre for the AIDS Programme of Research in South Africa 004 trial. In this trial, a 1% tenofovir gel was found to reduce women’s risk for HIV acquisition by 39% compared to placebo. To understand the impact of this trial on future microbicide development, we must view it from the historical perspective of previous phases 2 and 3 clinical trials with detergents and sulfated polyanions. This knowledge and emerging information must then be parlayed into the next steps needed to create a safe, effective, and acceptable topical microbicide. This review will look at the lessons learned from preclinical and clinical development of topical microbicides, focusing on two significant future challenges: (1) topical microbicide formulation safety and (2) the critical role that adherence to product use has in determining safety and efficacy in clinical trials and ultimately commercial viability of the licensed product. In addition to framing these issues within our current understanding of formulation and prevention of HIV acquisition, recent advances in our understanding of the mechanism of HIV transmission and how it informs on future formulation strategies will be briefly discussed