Procedure for the identification of population characteristics for targeting intervention services on the basis of outcome-goal priorities: Case management services for the chronic mentally ill

Although the processes involved in rational patient targeting may be obvious for certain services, for others, both the appropriate sub-populations to receive services and the procedures to be used for their identification may be unclear. This project was designed to address several research questions which arise in the attempt to deliver appropriate services to specific populations. The related difficulties are particularly evident for those interventions about which findings regarding effectiveness are conflicting. When an intervention clearly is not beneficial (or is dangerous) to a large, diverse population, consensus regarding withholding the intervention from dissemination can easily be reached. When findings are ambiguous, however, conclusions may be impossible.^ When characteristics of patients likely to benefit from an intervention are not obvious, and when the intervention is not significantly invasive or dangerous, the strategy proposed herein may be used to identify specific characteristics of sub-populations which may benefit from the intervention. The identification of these populations may be used both in further informing decisions regarding distribution of the intervention and for purposes of planning implementation of the intervention by identifying specific target populations for service delivery.^ This project explores a method for identifying such sub-populations through the use of related datasets generated from clinical trials conducted to test the effectiveness of an intervention. The method is specified in detail and tested using the example intervention of case management for outpatient treatment of populations with chronic mental illness. These analyses were applied in order to identify any characteristics which distinguish specific sub-populations who are more likely to benefit from case management service, despite conflicting findings regarding its effectiveness for the aggregate population, as reported in the body of related research. However, in addition to a limited set of characteristics associated with benefit, the findings generated, a larger set of characteristics of patients likely to experience greater improvement without intervention. ^

Major and trace element content of the 17 lithostratigraphic units recovered during DSDP Leg 49 (Table 1)

IPOD Leg 49 recovered basalts from 9 holes at 7 sites along 3 transects across the Mid-Atlantic Ridge: 63°N (Reykjanes), 45°N and 36°N (FAMOUS area). This has provided further information on the nature of mantle heterogeneity in the North Atlantic by enabling studies to be made of the variation of basalt composition with depth and with time near critical areas (Iceland and the Azores) where deep mantle plumes are thought to exist. Over 150 samples have been analysed for up to 40 major and trace elements and the results used to place constraints on the petrogenesis of the erupted basalts and hence on the geochemical nature of their source regions. It is apparent that few of the recovered basalts have the geochemical characteristics of typical "depleted" midocean ridge basalts (MORB). An unusually wide range of basalt compositions may be erupted at a single site: the range of rare earth patterns within the short section cored at Site 413, for instance, encompasses the total variation of REE patterns previously reported from the FAMOUS area. Nevertheless it is possible to account for most of the compositional variation at a single site by partial melting processes (including dynamic melting) and fractional crystallization. Partial melting mechanisms seem to be the dominant processes relating basalt compositions, particularly at 36°N and 45°N, suggesting that long-lived sub-axial magma chambers may not be a consistent feature of the slow-spreading Mid-Atlantic Ridge. Comparisons of basalts erupted at the same ridge segment for periods of the order of 35 m.y. (now lying along the same mantle flow line) do show some significant inter-site differences in Rb/Sr, Ce/Yb, 87Sr/86Sr, etc., which cannot be accounted for by fractionation mechanisms and which must reflect heterogeneities in the mantle source. However when hygromagmatophile (HYG) trace element levels and ratios are considered, it is the constancy or consistency of these HYG ratios which is the more remarkable, implying that the mantle source feeding a particular ridge segment was uniform with respect to these elements for periods of the order of 35 m.y. and probably since the opening of the Atlantic. Yet these HYG element ratios at 63°N are very different from those at 45°N and 36°N and significantly different from the values at 22°N and in "MORB". The observed variations are difficult to reconcile with current concepts of mantle plumes and binary mixing models. The mantle is certainly heterogeneous, but there is not simply an "enriched" and a "depleted" source, but rather a range of sources heterogeneous on different scales for different elements - to an extent and volume depending on previous depletion/enrichment events. HYG element ratios offer the best method of defining compositionally different mantle segments since they are little modified by the fractionation processes associated with basalt generation.

TectoRNA: modular assembly units for the construction of RNA nano-objects

Structural information on complex biological RNA molecules can be exploited to design tectoRNAs or artificial modular RNA units that can self-assemble through tertiary interactions thereby forming nanoscale RNA objects. The selective interactions of hairpin tetraloops with their receptors can be used to mediate tectoRNA assembly. Here we report on the modulation of the specificity and the strength of tectoRNA assembly (in the nanomolar to micromolar range) by variation of the length of the RNA subunits, the nature of their interacting motifs and the degree of flexibility of linker regions incorporated into the molecules. The association is also dependent on the concentration of magnesium. Monitoring of tectoRNA assembly by lead(II) cleavage protection indicates that some degree of structural flexibility is required for optimal binding. With tectoRNAs one can compare the binding affinities of different tertiary motifs and quantify the strength of individual interactions. Furthermore, in analogy to the synthons used in organic chemistry to synthesize more complex organic compounds, tectoRNAs form the basic assembly units for constructing complex RNA structures on the nanometer scale. Thus, tectoRNA provides a means for constructing molecular scaffoldings that organize functional modules in three-dimensional space for a wide range of applications.