Regulation of human (adrenal) androgen biosynthesis-New insights from novel throughput technology studies

Androgens are precursors for sex steroids and are predominantly produced in the human gonads and the adrenal cortex. They are important for intrauterine and postnatal sexual development and human reproduction. Although human androgen biosynthesis has been extensively studied in the past, exact mechanisms underlying the regulation of androgen production in health and disease remain vague. Here, the knowledge on human androgen biosynthesis and regulation is reviewed with a special focus on human adrenal androgen production and the hyperandrogenic disorder of polycystic ovary syndrome (PCOS). Since human androgen regulation is highly specific without a good animal model, most studies are performed on patients harboring inborn errors of androgen biosynthesis, on human biomaterials and human (tumor) cell models. In the past, most studies used a candidate gene approach while newer studies use high throughput technologies to identify novel regulators of androgen biosynthesis. Using genome wide association studies on cohorts of patients, novel PCOS candidate genes have been recently described. Variant 2 of the DENND1A gene was found overexpressed in PCOS theca cells and confirmed to enhance androgen production. Transcriptome profiling of dissected adrenal zones established a role for BMP4 in androgen synthesis. Similarly, transcriptome analysis of human adrenal NCI-H295 cells identified novel regulators of androgen production. Kinase p38α (MAPK14) was found to phosphorylate CYP17 for enhanced 17,20 lyase activity and RARB and ANGPTL1 were detected in novel networks regulating androgens. The discovery of novel players for androgen biosynthesis is of clinical significance as it provides targets for diagnostic and therapeutic use.

Barriers and facilitators to nurses' acceptance of and implications for injury rates of an IV catheter safety device

This study has the purpose of determining the barriers and facilitators to nurses' acceptance of the Johnson and Johnson Protectiv®* Plus IV catheter safety needle device and implications for needlestick injuries at St. Luke's Episcopal Hospital, Houston, Texas. A one-time cross-sectional survey of 620 responding nurses was conducted by this researcher during December, 2000. The study objectives were to: (1) describe the perceived (a) organizational and individual barriers and facilitators and (b) acceptance of implementation of the IV catheter device; (2) examine the relative importance of these predictors; (3) describe (a) perceived changes in needlestick injuries after implementation of the device; (b) the reported incidence of injuries; and (c) the extent of underreporting by nurses; and (4) examine the relative importance of (a) the preceding predictors and (b) acceptance of the device in predicting perceived changes in needlestick injuries. Safety climate and training were evaluated as organizational factors. Individual factors evaluated were experience with the device, including time using it and frequency of use, and background information, including nursing unit, and length of time as a nurse in this hospital and in total nursing career. The conceptual framework was based upon the safety climate model. Descriptive statistics and multiple and logistic regression were utilized to address the study objectives. ^ The findings showed widespread acceptance of the device and a strong perception that it reduced the number of needlesticks. Acceptance was notably predicted by adequate training, appropriate time between training and device use, solid safety climate, and short length of service, in that order. A barrier to acceptance was nurses' longtime of use of previous needle technologies. Over four-fifths of nurses were compliant in always using the device. Compliance had two facilitators: length of time using device and, to a lesser extent, safety climate. Rates of compliance tended to be lower among nurses in units in which the device was frequently used. ^ High quality training and an atmosphere of caring about nurse safety stand out as primary facilitators that other institutions would need to adopt in order to achieve maximum success in implementing safety programs involving utilization of new safety devices. ^

An Economic Model of Fair Use

The doctrine of fair use allows unauthorized copying of original works of art, music, and literature for limited purposes like criticism, research, and education, based on the rationale that copyright holders would consent to such uses if bargaining were possible. This paper develops the first formal analysis of fair use in an effort to derive the efficient legal standard for applying the doctrine. The model interprets copies and originals as differentiated products and defines fair use as a threshold separating permissible copying from infringement. Application of the analysis to several key cases (including the recent Napster case) shows that this interpretation is consistent with actual legal reasoning. The analysis also underscores the role of technology in shaping the efficient scope of fair use.

A Model of Endogenous Union Density and Membership

We develop a theoretical model of endogenously determined union density and union membership. A union is formed, continued, or dissolved by majority voting. Given the profitability, production technology, and labor and product market conditions, the union determines the reservation wage that is acceptable to the firm. Based on this reservation wage and other subjective factors, workers vote for or against the union. If the union is formed, the firm determines the employment level at the union wage.

An Economic Model of Fair Use

The doctrine of fair use allows limited copying of creative works based on the rationale that copyright holders would consent to such uses if bargaining were possible. This paper develops a formal model of fair use in an effort to derive the efficient legal standard for applying the doctrine. The model interprets copies and originals as differentiated products and defines fair use as a threshold separating permissible copying from infringement. The analysis highlights the role of technology in shaping the efficient standard. Discussion of several key cases illustrates the applicability of the model.

Systematic review of acceptance of the influenza vaccine among pregnant women

Exposure to influenza places pregnant women at risk for pneumonia and their fetus at risk for premature delivery or fatal stillbirth secondary to maternal hypoxia. Immunization rates are low among pregnant women. Influenza vaccine specific-health belief model constructs, such as cue to action messages from the health care professionals, may increase acceptance of the vaccine and improve immunization rates. A systematic review was conducted to evaluate the impact of physician recommendation upon acceptance of the influenza vaccine by pregnant women. Pregnant women were more likely to accept the influenza vaccine if they received a recommendation from their physician. These women were also more likely to accept the vaccine if they thought the vaccine protected mother and fetus against adverse effects of influenza and were less likely to accept the vaccine if they were concerned about side effects or risk to the fetus from the vaccine.^

STRATEGIES FOR THE TRANSFER OF APPROPRIATE TECHNOLOGY TO DEVELOPING COUNTRIES: THE IMPLEMENTATION AND DEVELOPMENT OF ENVIRONMENTAL HEALTH PROGRAMS IN TUNISIA

This dissertation focuses on Project HOPE, an American medical aid agency, and its work in Tunisia. More specifically this is a study of the implementation strategies of those HOPE sponsored projects and programs designed to solve the problems of high morbidity and infant mortality rates due to environmentally related diarrheal and enteric diseases. Several environmental health programs and projects developed in cooperation with Tunisian counterparts are described and analyzed. These include (1) a paramedical manpower training program; (2) a national hospital sanitation and infection control program; (3) a community sewage disposal project; (4) a well reconstruction project; and (5) a solid-waste disposal project for a hospital.^ After independence, Tunisia, like many developing countries, encountered several difficulties which hindered progress toward solving basic environmental health problems and prompted a request for aid. This study discusses the need for all who work in development programs to recognize and assess those difficulties or constraints which affect the program planning process, including those latent cultural and political constraints which not only exist within the host country but within the aid agency as well. For example, failure to recognize cultural differences may adversely affect the attitudes of the host staff towards their work and towards the aid agency and its task. These factors, therefore, play a significant role in influencing program development decisions and must be taken into account in order to maximize the probability of successful outcomes.^ In 1969 Project HOPE was asked by the Tunisian government to assist the Ministry of Health in solving its health manpower problems. HOPE responded with several programs, one of which concerned the training of public health nurses, sanitary technicians, and aids at Tunisia's school of public health in Nabeul. The outcome of that program as well as the strategies used in its development are analyzed. Also, certain questions are addressed such as, what should the indicators of success be, and when is the time right to phase out?^ Another HOPE program analyzed involved hospital sanitation and infection control. Certain generic aspects of basic hospital sanitation procedures were documented and presented in the form of a process model which was later used as a "microplan" in setting up similar programs in other Tunisian hospitals. In this study the details of the "microplan" are discussed. The development of a nation-wide program without any further need of external assistance illustrated the success of HOPE's implementation strategies.^ Finally, although it is known that the high incidence of enteric disease in developing countries is due to poor environmental sanitation and poor hygiene practices, efforts by aid agencies to correct these conditions have often resulted in failure. Project HOPE's strategy was to maximize limited resources by using a systems approach to program development and by becoming actively involved in the design and implementation of environmental health projects utilizing "appropriate" technology. Three innovative projects and their implementation strategies (including technical specifications) are described.^ It is advocated that if aid agencies are to make any progress in helping developing countries basic sanitation problems, they must take an interdisciplinary approach to progrm development and play an active role in helping counterparts seek and identify appropriate technologies which are socially and economically acceptable. ^

Assessing the impact of electronic health record technology adoption on hospital labor efficiency

Information technology (IT) in the hospital organization is fast becoming a key asset, particularly in light of recent reform legislation in the United States calling for expanding the role of IT in our health care system. Future payment reductions to hospitals included in current health reform are based on expected improvements in hospital operating efficiency. Since over half of hospital expenses are for labor, improved efficiency in use of labor resources can be critical in meeting this challenge. Policy makers have touted the value of IT investments to improve efficiency in response to payment reductions. ^ This study was the first to directly examine the relationship between electronic health record (EHR) technology and staffing efficiency in hospitals. As the hospital has a myriad of outputs for inpatient and outpatient care, efficiency was measured using an industry standard performance metric – full time equivalent employees per adjusted occupied bed (FTE/AOB). Three hypotheses were tested in this study.^ To operationalize EHR technology adoption, we developed three constructs to model adoption, each of which was tested by separate hypotheses. The first hypothesis that a larger number of EHR applications used by a hospital would be associated with greater staffing efficiency (or lower values of FTE/AOB) was not accepted. Association between staffing efficiency and specific EHR applications was the second hypothesis tested and accepted with some applications showing significant impacts on observed values for FTE/AOB. Finally, the hypothesis that the longer an EHR application was used in a hospital would be associated with greater labor efficiency was not accepted as the model showed few statistically significant relationships to FTE/AOB performance. Generally, there does not appear a strong relationship between EHR usage and improved labor efficiency in hospitals.^ While returns on investment from EHR usage may not come from labor efficiencies, they may be better sought using measures of quality, contribution to an efficient and effective local health care system, and improved customer satisfaction through greater patient throughput.^

Assessing and applying evidence-based interventions at the community level in India as a model policy to reduce neonatal mortality rates in Nigeria

Background. The United Nations' Millennium Development Goal (MDG) 4 aims for a two-thirds reduction in death rates for children under the age of five by 2015. The greatest risk of death is in the first week of life, yet most of these deaths can be prevented by such simple interventions as improved hygiene, exclusive breastfeeding, and thermal care. The percentage of deaths in Nigeria that occur in the first month of life make up 28% of all deaths under five years, a statistic that has remained unchanged despite various child health policies. This paper will address the challenges of reducing the neonatal mortality rate in Nigeria by examining the literature regarding efficacy of home-based, newborn care interventions and policies that have been implemented successfully in India. ^ Methods. I compared similarities and differences between India and Nigeria using qualitative descriptions and available quantitative data of various health indicators. The analysis included identifying policy-related factors and community approaches contributing to India's newborn survival rates. Databases and reference lists of articles were searched for randomized controlled trials of community health worker interventions shown to reduce neonatal mortality rates. ^ Results. While it appears that Nigeria spends more money than India on health per capita ($136 vs. $132, respectively) and as percent GDP (5.8% vs. 4.2%, respectively), it still lags behind India in its neonatal, infant, and under five mortality rates (40 vs. 32 deaths/1000 live births, 88 vs. 48 deaths/1000 live births, 143 vs. 63 deaths/1000 live births, respectively). Both countries have comparably low numbers of healthcare providers. Unlike their counterparts in Nigeria, Indian community health workers receive training on how to deliver postnatal care in the home setting and are monetarily compensated. Gender-related power differences still play a role in the societal structure of both countries. A search of randomized controlled trials of home-based newborn care strategies yielded three relevant articles. Community health workers trained to educate mothers and provide a preventive package of interventions involving clean cord care, thermal care, breastfeeding promotion, and danger sign recognition during multiple postnatal visits in rural India, Bangladesh, and Pakistan reduced neonatal mortality rates by 54%, 34%, and 15–20%, respectively. ^ Conclusion. Access to advanced technology is not necessary to reduce neonatal mortality rates in resource-limited countries. To address the urgency of neonatal mortality, countries with weak health systems need to start at the community level and invest in cost-effective, evidence-based newborn care interventions that utilize available human resources. While more randomized controlled studies are urgently needed, the current available evidence of models of postnatal care provision demonstrates that home-based care and health education provided by community health workers can reduce neonatal mortality rates in the immediate future.^

Efficiency from pharmacy inventory technology: A means to improving quality in non-profit hospitals

Hospitals, like all organizations, have both a mission and a finite supply of resources with which to accomplish that mission. Because the inventory of therapeutic drugs is among the more expensive resources needed by a hospital to achieve its mission, a conceptual model of structure plus process equals outcome posits that adequate emphasis should be placed on optimization of the organization's investment in this important structural resource to provide highest quality outcomes. Therefore emphasis should be placed on the optimization of pharmacy inventory because lowering the financial investment in drug inventory and associated costs increases productive efficiency, a key element of quality. ^ In this study, a post-intervention analysis of a hospital pharmacy inventory management technology implementation at The University of Texas M.D. Anderson Cancer Center was conducted to determine if an intervention which reduced a hospital's financial investment in pharmaceutical inventory provided an opportunity to incrementally optimize the organization's mix of structural resources thereby improving quality of care. The results suggest that hospital pharmacies currently lacking technology to support automated purchasing logistics and perpetual, real-time inventory management for drugs may achieve measurable benefits from the careful implementation of such technology, enabling the hospital to lower its investment in on-hand inventory and, potentially, to reduce overall purchasing expenditures. ^ The importance of these savings to the hospital and potentially to the patient should not be underestimated for their ability to generate funding for previously unfunded public health programs or in their ability to provide financial relief to patients in the form of lower drug costs given the current climate of escalating healthcare costs and tightening reimbursements.^

Territorial quality and sustainable development : Indicators of performance in the context of a model for participatory rural tourism certification

El turismo rural ha sido incorporado por pequeños establecimientos agropecuarios del partido de Cnel. Suárez, provincia de Buenos Aires, Argentina, como actividad alternativa para mejorar la calidad de vida de sus miembros y superar situaciones de crisis agravadas por la marginalidad productiva del SO bonaerense, región a la que pertenecen. Bajo el programa Cambio Rural del INTA (Instituto Nacional de Tecnología Agropecuaria) conforman el Grupo 'Cortaderas II', junto a otros emprendedores interesados en valorar el medio rural. Han avanzado en el proceso de reconocimiento de su identidad y puesta en valor de recursos específicos con anclaje en el territorio. Esta identidad comienza a apreciarse internamente, a raíz de la dinámica grupal lograda y la incipiente articulación con otros actores para la construcción de un partenariado público y privado que genere sinergias y contribuya al desarrollo sustentable del territorio. Sin embargo, aún no es claramente percibida por el turista, cada vez más exigente. Por lo tanto, el presente trabajo persigue proponer indicadores para evaluar el desempeño de un Sistema de Gestión de Calidad con enfoque territorial que, adaptando el modelo europeo 'Marca de Calidad Territorial', sustente una estrategia comercial de diferenciación del servicio y simultáneamente, mida el progreso hacia una mejor calidad de vida y fortalecimiento de vínculos con la cultura local y el entorno físico-natural en el marco del desarrollo sustentable. La investigación se plantea para la micro escala, ya que se trata de un estudio de caso, relevándose información primaria mediante observación directa y entrevistas semi-estructuradas, complementada con información secundaria diagnóstica utilizada por INTA. Las características del grupo y su dinámica de funcionamiento bajo el programa Cambio Rural revelan que es posible adoptar un proceso de certificación participativa propuesto para cuatro pilares de la calidad: de Bienes y Servicios, Institucional, Social y Ambiental. El modelo se integra con indicadores de evaluación de desempeño, agrupados en áreas clave para cada una de las dimensiones de la sustentabilidad, que contemplan el paisaje y la gestión de los recursos naturales; el impacto económico de la actividad, la calidad de la oferta y satisfacción del turista; así como las relaciones sociales internas y los vínculos con otros actores del territorio. Principalmente se encontraron fortalezas en la búsqueda de partenariados y debilidades en aspectos de comunicación y promoción. Se considera que este sistema de herramientas de gestión sustentable permitiría superar las dificultades de una certificación individual, pudiendo aplicarse a emprendimientos con otra ubicación geográfica

Model of ICT skills and new professional profile of the Guidance Counsellors in some European countries

El artículo analiza la utilización de las Tecnologías de la Información y Comunicación en el escenario de algunos países europeos en el ámbito de la Orientación Educativa y Profesional.

Model of ICT skills and new professional profile of the Guidance Counsellors in some European countries

El artículo analiza la utilización de las Tecnologías de la Información y Comunicación en el escenario de algunos países europeos en el ámbito de la Orientación Educativa y Profesional.

Territorial quality and sustainable development : Indicators of performance in the context of a model for participatory rural tourism certification

El turismo rural ha sido incorporado por pequeños establecimientos agropecuarios del partido de Cnel. Suárez, provincia de Buenos Aires, Argentina, como actividad alternativa para mejorar la calidad de vida de sus miembros y superar situaciones de crisis agravadas por la marginalidad productiva del SO bonaerense, región a la que pertenecen. Bajo el programa Cambio Rural del INTA (Instituto Nacional de Tecnología Agropecuaria) conforman el Grupo 'Cortaderas II', junto a otros emprendedores interesados en valorar el medio rural. Han avanzado en el proceso de reconocimiento de su identidad y puesta en valor de recursos específicos con anclaje en el territorio. Esta identidad comienza a apreciarse internamente, a raíz de la dinámica grupal lograda y la incipiente articulación con otros actores para la construcción de un partenariado público y privado que genere sinergias y contribuya al desarrollo sustentable del territorio. Sin embargo, aún no es claramente percibida por el turista, cada vez más exigente. Por lo tanto, el presente trabajo persigue proponer indicadores para evaluar el desempeño de un Sistema de Gestión de Calidad con enfoque territorial que, adaptando el modelo europeo 'Marca de Calidad Territorial', sustente una estrategia comercial de diferenciación del servicio y simultáneamente, mida el progreso hacia una mejor calidad de vida y fortalecimiento de vínculos con la cultura local y el entorno físico-natural en el marco del desarrollo sustentable. La investigación se plantea para la micro escala, ya que se trata de un estudio de caso, relevándose información primaria mediante observación directa y entrevistas semi-estructuradas, complementada con información secundaria diagnóstica utilizada por INTA. Las características del grupo y su dinámica de funcionamiento bajo el programa Cambio Rural revelan que es posible adoptar un proceso de certificación participativa propuesto para cuatro pilares de la calidad: de Bienes y Servicios, Institucional, Social y Ambiental. El modelo se integra con indicadores de evaluación de desempeño, agrupados en áreas clave para cada una de las dimensiones de la sustentabilidad, que contemplan el paisaje y la gestión de los recursos naturales; el impacto económico de la actividad, la calidad de la oferta y satisfacción del turista; así como las relaciones sociales internas y los vínculos con otros actores del territorio. Principalmente se encontraron fortalezas en la búsqueda de partenariados y debilidades en aspectos de comunicación y promoción. Se considera que este sistema de herramientas de gestión sustentable permitiría superar las dificultades de una certificación individual, pudiendo aplicarse a emprendimientos con otra ubicación geográfica

Model of ICT skills and new professional profile of the Guidance Counsellors in some European countries

El artículo analiza la utilización de las Tecnologías de la Información y Comunicación en el escenario de algunos países europeos en el ámbito de la Orientación Educativa y Profesional.