bluuebunny/crossref_metadata_2025 huggingface dataset:
Influenza Among Healthy Young Children: Changes in Parental Attitudes and Predictors of Immunization During the 2003 to 2004 Influenza Season
Authors: Daley Matthew F. , Crane Lori A. , Chandramouli Vijayalaxmi , Beaty Brenda L. , Barrow Jennifer , Allred Norma , Berman Stephen , Kempe Allison
Published: February 2006

BACKGROUND. In Colorado, the 2003 to 2004 influenza season was unusually early and severe and received substantial media attention.

OBJECTIVES. Among parents of healthy young children, to determine how parental knowledge and attitudes regarding influenza infection and immunization changed during the 2003 to 2004 influenza season and to identify factors predictive of influenza immunization.

METHODS. The study was conducted in 5 metropolitan Denver pediatric practices. A total of 839 healthy children age 6 to 21 months and their parents were randomly selected for participation. Parents were surveyed by telephone before (August 18 to October 7, 2003) and after (March 31 to June 10, 2004) the influenza season.

RESULTS. Among 828 eligible parents, 472 (57%) completed the preseason survey; 316 (67%) of these parents subsequently completed the postseason survey. All analyses were performed for the 316 subjects who completed both preseason and postseason surveys. Compared with their attitudes before the influenza season, 48% of parents interviewed after the season viewed their child as more susceptible to influenza, 58% viewed influenza infections as more severe, and 66% perceived fewer risks associated with influenza vaccine. Ninety-five percent of parents reported hearing in the media about Colorado’s influenza outbreak, and having heard about the outbreak in the media was associated with viewing influenza infections as more severe. A total of 258 parents (82%) immunized their child against influenza. In multivariate analyses, positive predictors of immunization included a physician recommendation for immunization and a preseason to postseason increase in the perception that immunization was the social norm. Negative predictors of immunization included high perceived barriers to immunization, less parental education, and preseason intention not to immunize.

CONCLUSIONS. Parent attitudes about influenza infection and immunization changed substantially during the 2003 to 2004 influenza season, with changes favoring increased parental acceptance of influenza vaccination for young children. During an intensively publicized influenza outbreak, a physician recommendation of vaccination was an important predictor of influenza immunization.
Dietary Recommendations for Children and Adolescents: A Guide for Practitioners
Authors:   American Heart Association, Gidding Samuel S. , Dennison Barbara A. , Birch Leann L. , Daniels Stephen R. , Gilman Matthew W. , Lichtenstein Alice H. , Rattay Karyl Thomas , Steinberger Julia , Stettler Nicolas , Van Horn Linda
Published: February 2006

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children's cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.
Screening Examination of Premature Infants for Retinopathy of Prematurity
Authors:   Section on Ophthalmology,   American Academy of Pediatrics,   American Academy of Ophthalmology,   American Association for Pediatric Ophthalmology and Strabismus
Published: February 2006

This statement revises a previous statement on screening of preterm infants for retinopathy of prematurity (ROP) that was published in 2001. ROP is a pathologic process that occurs only in immature retinal tissue and can progress to a tractional retinal detachment, which can result in functional or complete blindness. Recent development of peripheral retinal ablative therapy using laser photocoagulation has resulted in the possibility of markedly decreasing the incidence of this poor visual outcome, but the sequential nature of ROP creates a requirement that at-risk preterm infants be examined at proper times to detect the changes of ROP before they become permanently destructive. This statement presents the attributes on which an effective program for detecting and treating ROP could be based, including the timing of initial examination and subsequent reexamination intervals.
Reducing the Risk of HIV Infection Associated With Illicit Drug Use
Authors:   Committee on Pediatric AIDS
Published: February 2006

This Policy Statement was retired December 2015.

Substance abuse, specifically the use of illicit drugs that are administered intravenously, continues to play a role in the transmission of human immunodeficiency virus type 1 (HIV-1) among adolescents and young adults (youth). Risks of HIV-1 infection may result from direct exposure to contaminated blood through sharing of injection drug equipment and from unsafe sexual practices (while under the influence of drugs and/or in exchange for drugs). Reducing the risk of HIV-1 infection that is associated with illicit drug use requires prevention education and prompt engagement in treatment. Providing patients with education, instruction on decontamination of used injection drug equipment, improved access to sterile syringes and needles, and postexposure prophylaxis may decrease their risk of acquiring HIV-1 infection. Pediatricians should assess risk behaviors as part of every health care encounter, including queries about tobacco, alcohol, and marijuana use. The risks and benefits of postexposure prophylaxis with antiretroviral drugs should be considered for youth with a single recent (within 72 hours) high-risk exposure to HIV-1 through sharing needles/syringes with an HIV-1–infected individual or having unprotected intercourse with an individual who engages in injection drug use. Such prophylaxis must be accompanied by risk-reduction counseling, appropriate referrals for treatment, and evaluation for pregnancy and associated sexually transmitted infections. There is an urgent need for more substance-abuse prevention and treatment programs, legislation that facilitates unencumbered access to sterile syringes, and expedient availability of reproductive health care services for sexually active youth, including voluntary HIV-1 counseling and testing.
The Pediatrician and Disaster Preparedness
Authors: Markenson David , Reynolds Sally ,   Committee on Pediatric Emergency Medicine and Task Force on Terrorism
Published: February 2006

This Technical Report was retired August 2012.

For decades, emergency planning for natural disasters, public health emergencies, workplace accidents, and other calamities has been the responsibility of government agencies on all levels and certain nongovernment organizations such as the American Red Cross. In the case of terrorism, however, entirely new approaches to emergency planning are under development for a variety of reasons. Terrorism preparedness is a highly specific component of general emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, terrorism preparedness must consider several additional issues, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if they are not monitored carefully.

This article is designed to provide an overview of key issues for the pediatrician with respect to disaster, terrorism, and public health emergency preparedness. It is not intended to be a complete compendium of didactic content but rather offers an approach to what pediatricians need to know and how pediatricians must lend their expertise to enhance preparedness in every community. To become fully and optimally prepared, pediatricians need to become familiar with these key areas of emergency preparedness: unique aspects of children related to terrorism and other disasters; terrorism preparedness; mental health vulnerabilities and development of resiliency; managing family concerns about terrorism and disaster preparedness; office-based preparedness; hospital preparedness; community, government, and public health preparedness; and advocating for children and families in preparedness planning.
Optimizing Bone Health and Calcium Intakes of Infants, Children, and Adolescents
Authors: Greer Frank R. , Krebs Nancy F. ,   Committee on Nutrition
Published: February 2006

This Clinical Report was retired October 2012.

Most older children and adolescents in the United States currently do not achieve the recommended intake of calcium. Maintaining adequate calcium intake during childhood and adolescence is necessary for the development of peak bone mass, which may be important in reducing the risk of fractures and osteoporosis later in life. Optimal calcium intake is especially relevant during adolescence, when most bone mineral accretion occurs. Because of the influence of the family's diet on the diet of children and adolescents, adequate calcium intake by all members of the family is important. Assessment of calcium intake can be performed in the physician's office. A well-rounded diet including low-fat dairy products, fruits, and vegetables and appropriate physical activity are important for achieving good bone health. Establishing these practices in childhood is important so that they will be followed throughout the life span.
Unexpected tunnelling volume losses in the Westminster area, London
Authors: Standing J. R. , Burland J. B.
Published: February 2006

During construction of the running tunnels for the Jubilee Line Extension, London, large variations in tunnelling volume loss were measured over about a 2 km distance between Waterloo, south of the Thames, and the area north of St James's Park. At the design stage, a value of volume loss of 2% was adopted, which was thought to be conservative. In practice, volume losses of greater than 3% were measured in Westminster and in St James's Park, south of the lake. North of the St James's Park lake volume losses were less than 2%, as expected. Reliable estimates of volume loss are required for the planning and approval of future tunnelling projects in London, and so a detailed investigation was undertaken to establish the reasons for the observed differences. Two primary and interlinked causes for the large volume losses are identified. First, the method of tunnelling and construction control: south of the lake up to 1·9 m of unsupported tunnel heading was often advanced ahead of the shield, and as a result about 50% of the measured volume loss occurred in front of the shield. Second, the geological conditions: the crown of the westbound tunnel lies just below, and the invert of the eastbound tunnel just above, a division of the London Clay that contains numerous sand and silt partings. There was therefore a considerable potential for loosening and softening, particularly with excavation significantly ahead of the shield. Also, there is less clay cover and lower strengths to the south of the lake owing to past erosion (the study area straddles two of the Thames terraces). This case study highlights the importance of taking the engineering geology into account, even in a city such as London where there are decades of experience of tunnelling and the ground conditions are well characterised. The message is equally applicable to many other cities where large subsurface infrastructure projects are planned.
Field trials of suction caissons in sand for offshore wind turbine foundations
Authors: Houlsby G. T. , Kelly R. B. , Huxtable J. , Byrne B. W.
Published: February 2006

A programme of testing on suction caisson foundations in an artificially prepared sand test bed near Luce Bay, in Scotland, is described. The tests are relevant to the design of either monopod or quadruped foundations for offshore wind turbines. Records are presented for suction installation of the caissons, cyclic moment loading under both quasi-static and dynamic conditions to simulate the behaviour of a monopod foundation, and cyclic vertical loading and pullout of caissons to simulate one footing in a quadruped foundation. Variations of stiffness with loading level of the foundation are observed, with high initial stiffness followed by hysteretic behaviour at moderate loads and degradation of response at high loads. Some implications for the design of wind turbine foundations are briefly discussed.
Effects of sample size on bender-based axial G0 measurements
Authors: Arroyo M. , Muir Wood D. , Greening P. D. , Medina L. , Rio J.
Published: February 2006

Bender elements are piezoelectric transducers frequently employed for the measurement of the small-strain shear modulus of soils. The measurement is based on transmission of a mechanical signal through a soil sample. A very common set-up involves transmission along the axis of a cylindrical sample, with source and receiver transducers mounted, for instance, in the end platens of a triaxial apparatus. Current test interpretation is generally based on the assumption of plane wave transmission between transducers. However, this model does not explain the heavily distorted transmission usually observed. The result is substantial measurement uncertainty. Although other phenomena do play a role, it is here proposed that a main culprit for signal distortions is sample-size effects due to lateral boundary reflections. To support this hypothesis, results from a series of numerical 3D simulations of the problem are analysed. Velocity estimates obtained from the simulated traces using plane-wave based time and frequency domain methods are compared with the known exact value. Errors in velocity determination are shown to be very important and directly related to lateral boundary influences. Comparison with some experimental data confirms the need to include sample-size effects in a renewed interpretative framework for bender tests.
Sufficiency and Stability of Evidence for Public Health Interventions Using Cumulative Meta-Analysis
Authors: Muellerleile Paige , Mullen Brian
Published: February 2006

We propose cumulative meta-analysis as the procedure of completing a new meta-analysis at each successive wave in a research database. Two facets of cumulative knowledge are considered: the first, sufficiency, refers to whether the meta-analytic database adequately demonstrates that a public health intervention works. The second, stability, refers to the shifts over time in the accruing evidence about whether a public health intervention works.

We used a hypothetical data set to develop the indicators of sufficiency and stability, and then applied them to existing, published datasets. Our discussion centers on the implications of the use of this procedure in evaluating public health interventions.
Barriers to Contraceptive Use in Product Labeling and Practice Guidelines
Authors: Grossman Daniel , Ellertson Charlotte , Abuabara Katrina , Blanchard Kelly , Rivas Francisco T.
Published: February 2006

Many contraceptives are encumbered with potentially unnecessary restrictions on their use. Indeed, fear of side effects, fostered by alarmist labeling, is a leading reason that women do not use contraceptives.

In the United States, hormonal methods currently require a prescription, although research suggests that women can adequately screen themselves for contraindications, manage side effects, and determine an appropriate initiation date, leaving little need for routine direct physician involvement. Sizing, spermicidal use, and length-of-wear limits burden users of cervical barriers and may be unnecessary. Despite recent changes in the labeling of intrauterine devices, clinicians commonly restrict use of this method and in some countries may limit the types of providers authorized to insert them.

Although in some cases additional research is necessary, existing data indicate that evidence-based demedicalization of contraceptive provision could reduce costs and improve access.
Public Health Systems Research: Setting a National Agenda
Authors: Lenaway Dennis , Halverson Paul , Sotnikov Sergey , Tilson Hugh , Corso Liza , Millington Wayne
Published: February 2006

The Institute of Medicine has recommended that policy decisions about improvement of national public health systems be guided by sound scientific evidence. However, to date there is no national research agenda to help guide public health systems.

The Centers for Disease Control and Prevention was called upon to lead a collaborative consensus-based process to define key research questions and establish a framework to create opportunities to better coordinate, leverage, and identify public health resources, which are increasingly scarce. The public health systems research agenda that emerged from this process has 14 overarching priority research themes. This national agenda should stimulate and guide research to meet the urgent need to improve the nation’s public health systems.
The Formation of the Emergency Medical Services System
Authors: Shah Manish N.
Published: February 2006

The evolution of the emergency medical services system in the United States accelerated rapidly between 1960 and 1973 as a result of a number of medical, historical, and social forces. Current emergency medical services researchers, policy advocates, and administrators must acknowledge these forces and their limitations and work to modify the system into one that provides uniformly high-quality acute care to all patients, improves the overall public health through injury control and disease prevention programs, participates as a full partner in disease surveillance, and is prepared to address new community needs of all types.
Building True Capacity: Indigenous Models for Indigenous Communities
Authors: Chino Michelle , DeBruyn Lemyra
Published: February 2006

Within the past 2 decades, community capacity building and community empowerment have emerged as key strategies for reducing health disparities and promoting public health. As with other strategies and best practices, these concepts have been brought to indigenous (American Indian and Alaska Native) communities primarily by mainstream researchers and practitioners.

Mainstream models and their resultant programs, however, often have limited application in meeting the needs and realities of indigenous populations. Tribes are increasingly taking control of their local health care services. It is time for indigenous people not only to develop tribal programs but also to define and integrate the underlying theoretical and cultural frameworks for public health application.
Stigmatization of Newly Emerging Infectious Diseases: AIDS and SARS
Authors: Des Jarlais Don C. , Galea Sandro , Tracy Melissa , Tross Susan , Vlahov David
Published: February 2006

Objectives. We assessed relationships between sociodemographic characteristics and mental health status and knowledge of, being worried about, and stigmatization of 2 emerging infectious diseases: AIDS and SARS.

Methods. We conducted a random-digit-dialed survey of 928 residents of the New York City metropolitan area as part of a study of the effects of the September 11, 2001, terrorist attacks. Questions added for this study concerned respondents’ knowledge of, worry about, and support of stigmatizing actions to control AIDS and SARS.

Results. In general, respondents with greater personal resources (income, education, social support) and better mental health status had more knowledge, were less worried, and were less likely to stigmatize. This pattern held for both AIDS and SARS.

Conclusions. Personal resources and mental health factors are likely to influence the public’s ability to learn about, rationally appraise the threat of, and minimize stigmatization of emerging infectious diseases such as AIDS and SARS.
Public Health Lessons Learned From Analysis of New York City Subway Injuries
Authors: Guth Amber A. , O’Neill Andrea , Pachter H. Leon , Diflo Thomas
Published: February 2006

Serious subway injuries are devastating to their young victims and have high rates of mortality and amputation. We identified the urban population at greatest risk for subway injuries and investigated the influence of local economies on injury rates. We propose using changes in social conditions as a “trigger” for increased vigilance and protective measures at times of higher risk.
Helping Public Sector Health Systems Innovate: The Strategic Approach to Strengthening Reproductive Health Policies and Programs
Authors: Fajans Peter , Simmons Ruth , Ghiron Laura
Published: February 2006

Public sector health systems that provide services to poor and marginalized populations in developing countries face great challenges. Change associated with health sector reform and structural adjustment often leaves these already-strained institutions with fewer resources and insufficient capacity to relieve health burdens.

The Strategic Approach to Strengthening Reproductive Health Policies and Programs is a methodological innovation developed by the World Health Organization and its partners to help countries identify and prioritize their reproductive health service needs, test appropriate interventions, and scale up successful innovations to a subnational or national level. The participatory, interdisciplinary, and country-owned process can set in motion much-needed change.

We describe key features of this approach, provide illustrations from country experiences, and use insights from the diffusion of innovation literature to explain the approach’s dissemination and sustainability.
Vulnerability, Human Rights, and Comprehensive Health Care Needs of Young People Living With HIV/AIDS
Authors: Ayres José Ricardo de Carvalho Mesquita , Paiva Vera , França Ivan , Gravato Neide , Lacerda Regina , Della Negra Marinella , Marques Heloisa Helena de Sousa , Galano Eliana , Lecussan Pilar , Segurado Aluísio Cotrim , Silva Mariliza Henrique
Published: February 2006

We sought to identify and understand the health care needs of young people living with HIV/AIDS, particularly in terms of their psychosocial well-being. We conducted a qualitative analysis of HIV-positive young people and their caregivers, focusing on the implications of an HIV diagnosis for health care needs.

Stigma was a recurrent issue that arose in the interviews conducted with the respondents, and it was evident that youths had been denied many rights related to health. We concluded that young people living with HIV need comprehensive care based on a human rights approach. In this regard, we offer some practical recommendations for health programs.
Systems Analysis of Real-World Obstacles to Successful Cervical Cancer Prevention in Developing Countries
Authors: Suba Eric J. , Murphy Sean K. , Donnelly Amber D. , Furia Lisa M. , Huynh My Linh D. , Raab Stephen S.
Published: February 2006

Papanicolaou screening is feasible anywhere that screening for cervical cancer, the leading cause of cancer-related death among women in developing countries, is appropriate. After documenting that the Vietnam War had contributed to the problem of cervical cancer in Vietnam, we participated in a grassroots effort to establish a nationwide cervical cancer prevention program in that country and performed root cause analyses of program deficiencies.

We found that real-world obstacles to successful cervical cancer prevention in developing countries involve people far more than technology and that such obstacles can be appropriately managed through a systems approach focused on programmatic quality rather than through ideological commitments to technology. A focus on quality satisfies public health goals, whereas a focus on technology is compatible with market forces.
System Dynamics Modeling for Public Health: Background and Opportunities
Authors: Homer Jack B. , Hirsch Gary B.
Published: February 2006

The systems modeling methodology of system dynamics is well suited to address the dynamic complexity that characterizes many public health issues. The system dynamics approach involves the development of computer simulation models that portray processes of accumulation and feedback and that may be tested systematically to find effective policies for overcoming policy resistance.

System dynamics modeling of chronic disease prevention should seek to incorporate all the basic elements of a modern ecological approach, including disease outcomes, health and risk behaviors, environmental factors, and health-related resources and delivery systems. System dynamics shows promise as a means of modeling multiple interacting diseases and risks, the interaction of delivery systems and diseased populations, and matters of national and state policy.
A System for Rapidly and Accurately Collecting Patients’ Race and Ethnicity
Authors: Baker David W. , Cameron Kenzie A. , Feinglass Joseph , Thompson Jason A. , Georgas Patricia , Foster Shawn , Pierce Deborah , Hasnain-Wynia Romana
Published: February 2006

Objectives. We assessed the feasibility of collecting race/ethnicity data from patients using their own preferred racial/ethnic terms.

Methods. The 424 patients described their race/ethnicity using their own categories, and we compared their descriptions with their responses to the questions (1) “Do you consider yourself Latino or Hispanic?” and (2) “Which category best describes your race?” (7 response options in our computer interview). We also determined patients’ preferences between the 2 approaches.

Results.seconds. Rates of missing values and categorization as “other” race were lower than with the closed questions. Agreement between racial/ethnic categorization with open-ended and closed responses was 93% (κ =0.88). Latino/Hispanic and multiracial/multiethnic individuals were more likely to prefer using their own categories to describe their race/ethnicity.

Conclusions. Collecting race/ethnicity data using patients’ own racial/ethnic categories is feasible with the use of computerized systems to capture verbatim responses and results in lower rates of missing and unusable data than do standard questions.
A Societal Outcomes Map for Health Research and Policy
Authors: Garfinkel Michele S. , Sarewitz Daniel , Porter Alan L.
Published: February 2006

The linkages between decisions about health research and policy and actual health outcomes may be extraordinarily difficult to specify.

We performed a pilot application of a “road mapping” and technology assessment technique to perinatal health to illustrate how this technique can clarify the relations between available options and improved health outcomes. We used a combination of data-mining techniques and qualitative analyses to set up the underlying structure of a societal health outcomes road map.

Societal health outcomes road mapping may be a useful tool for enhancing the ability of the public health community, policymakers, and other stakeholders, such as research administrators, to understand health research and policy options.
The Impact of New York City’s 1975 Fiscal Crisis on the Tuberculosis, HIV, and Homicide Syndemic
Authors: Freudenberg Nicholas , Fahs Marianne , Galea Sandro , Greenberg Andrew
Published: February 2006

In 1975, New York City experienced a fiscal crisis rooted in long-term political and economic changes in the city. Budget and policy decisions designed to alleviate this fiscal crisis contributed to the subsequent epidemics of tuberculosis, human immunodeficiency virus (HIV) infection, and homicide in New York City.

Because these conditions share underlying social determinants, we consider them a syndemic, i.e., all 3 combined to create an excess disease burden on the population. Cuts in services; the dismantling of health, public safety, and social service infrastructures; and the deterioration of living conditions for vulnerable populations contributed to the amplification of these health conditions over 2 decades.

We estimate that the costs incurred in controlling these epidemics exceeded $50 billion (in 2004 dollars); in contrast, the overall budgetary saving during the fiscal crisis was $10 billion. This history has implications for public health professionals who must respond to current perceptions of local fiscal crises.
Complex Causal Process Diagrams for Analyzing the Health Impacts of Policy Interventions
Authors: Joffe Michael , Mindell Jennifer
Published: February 2006

Causal diagrams are rigorous tools for controlling confounding. They also can be used to describe complex causal systems, which is done routinely in communicable disease epidemiology. The use of change diagrams has advantages over static diagrams, because change diagrams are more tractable, relate better to interventions, and have clearer interpretations.

Causal diagrams are a useful basis for modeling. They make assumptions explicit, provide a framework for analysis, generate testable predictions, explore the effects of interventions, and identify data gaps. Causal diagrams can be used to integrate different types of information and to facilitate communication both among public health experts and between public health experts and experts in other fields. Causal diagrams allow the use of instrumental variables, which can help control confounding and reverse causation.
Institutional and Economic Determinants of Public Health System Performance
Authors: Mays Glen P. , McHugh Megan C. , Shim Kyumin , Perry Natalie , Lenaway Dennis , Halverson Paul K. , Moonesinghe Ramal
Published: February 2006

Objectives. Although a growing body of evidence demonstrates that availability and quality of essential public health services vary widely across communities, relatively little is known about the factors that give rise to these variations. We examined the association of institutional, financial, and community characteristics of local public health delivery systems and the performance of essential services.

Methods. Performance measures were collected from local public health systems in 7 states and combined with secondary data sources. Multivariate, linear, and nonlinear regression models were used to estimate associations between system characteristics and the performance of essential services.

Results. Performance varied significantly with the size, financial resources, and organizational structure of local public health systems, with some public health services appearing more sensitive to these characteristics than others. Staffing levels and community characteristics also appeared to be related to the performance of selected services.

Conclusions. Reconfiguring the organization and financing of public health systems in some communities—such as through consolidation and enhanced intergovernmental coordination—may hold promise for improving the performance of essential services.
Improving the Effectiveness of Health Care and Public Health: A Multiscale Complex Systems Analysis
Authors: Bar-Yam Yaneer
Published: February 2006

The US health care system is struggling with a mismatch between the large, simple (low-information) financial flow and the complex (high-information) treatment of individual patients. Efforts to implement cost controls and industrial efficiency that are appropriate for repetitive tasks but not high-complexity tasks lead to poor quality of care.

Multiscale complex systems analysis suggests that an important step toward relieving this structural problem is a separation of responsibility for 2 distinct types of tasks: medical care of individual patients and prevention/population health. These distinct tasks require qualitatively different organizational structures. The current use of care providers and organizations for both purposes leads to compromises in organizational process that adversely affect the ability of health care organizations to provide either individual or prevention/population services.

Thus, the overall system can be dramatically improved by establishing 2 separate but linked systems with distinct organizational forms: (a) a high-efficiency system performing large-scale repetitive tasks such as screening tests, inoculations, and generic health care, and (b) a high-complexity system treating complex medical problems of individual patients.
Toward Ethical Review of Health System Transformations
Authors: Daniels Norman
Published: February 2006

Efforts to transform health systems constitute social experiments on a population. Like clinical research, they deploy measures that are unproven in the context of the reform, and they often impose significant risks on some people in order to achieve a social goal: the improvement of health delivery.

The rationale for proactively evaluating clinical experimentation on human subjects also applies to these social experiments. We used the “benchmarks of fairness” methodology to illustrate the elements such an evidence-based review should encompass, leaving open the question of who should perform it. The review must include the ethical objectives of reform, namely, an integrated approach to equity, accountability, and efficiency; the fit between measures taken and these objectives; and the governance of the reform.
Public Health Asks of Systems Science: To Advance Our Evidence-Based Practice, Can You Help Us Get More Practice-Based Evidence?
Authors: Green Lawrence W.
Published: February 2006

Public health asks of systems science, as it did of sociology 40 years ago, that it help us unravel the complexity of causal forces in our varied populations and the ecologically layered community and societal circumstances of public health practice.

We seek a more evidence-based public health practice, but too much of our evidence comes from artificially controlled research that does not fit the realities of practice.

What can we learn from our experience with sociology in the past that might guide us in drawing effectively on systems science?
Learning from Evidence in a Complex World
Authors: Sterman John D.
Published: February 2006

Policies to promote public health and welfare often fail or worsen the problems they are intended to solve. Evidence-based learning should prevent such policy resistance, but learning in complex systems is often weak and slow. Complexity hinders our ability to discover the delayed and distal impacts of interventions, generating unintended “side effects.” Yet learning often fails even when strong evidence is available: common mental models lead to erroneous but self-confirming inferences, allowing harmful beliefs and behaviors to persist and undermining implementation of beneficial policies.

Here I show how systems thinking and simulation modeling can help expand the boundaries of our mental models, enhance our ability to generate and learn from evidence, and catalyze effective change in public health and beyond.
HIV/AIDS and Other Infectious Diseases Among Correctional Inmates: Transmission, Burden, and an Appropriate Response
Authors: Hammett Theodore M.
Published: February 2006

Correctional inmates engage in drug-related and sexual risk behaviors, and the transmission of HIV, hepatitis, and sexually transmitted diseases occurs in correctional facilities. However, there is uncertainty about the extent of transmission, and hyperbolic descriptions of its extent may further stigmatize inmates and elicit punitive responses.

Whether infection was acquired within or outside correctional facilities, the prevalence of HIV and other infectious diseases is much higher among inmates than among those in the general community, and the burden of disease among inmates and releasees is disproportionately heavy. A comprehensive response is needed, including voluntary counseling and testing on request that is linked to high-quality treatment, disease prevention education, substance abuse treatment, and discharge planning and transitional programs for releasees.
Systemic Intervention for Public Health
Authors: Midgley Gerald
Published: February 2006

Many calls have been made for a systems approach to public health. My response is to offer a methodology for systemic intervention that (1) emphasizes the need to explore stakeholder values and boundaries for analysis, (2) challenges marginalization, and (3) draws upon a wide range of methods (from the systems literature and beyond) to create a flexible and responsive systems practice.

I present and discuss several well-tested methods with a view to identifying their potential for supporting systemic intervention for public health.
Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis
Authors: Weinshenker Brian G. , Wingerchuk Dean M. , Vukusic Sandra , Linbo Linda , Pittock Sean J. , Lucchinetti Claudia F. , Lennon Vanda A.
Published: February 2006

Objective

We investigated whether neuromyelitis optica (NMO) IgG seropositivity at the initial presentation of longitudinally extensive transverse myelitis (LETM) predicts relapse of myelitis or development of optic neuritis.

Methods

Prospective study of patients with initial LETM who were tested for the presence of NMO‐IgG.

Results

Eleven of 29 patients (37.9%) were seropositive after a first attack of LETM spanning three or more vertebral segments on magnetic resonance imaging. Of 23 patients followed up for 1 year, none of 14 who were seronegative experienced a relapse or developed optic neuritis. Of 9 seropositive patients, 5 developed a second event: 4 of 9 (44%) developed recurrent transverse myelitis and 1 of 9 (11%) developed optic neuritis (p = 0.004).

Interpretation

LETM represents an inaugural or limited form of NMO in a high proportion of patients. The 40% of patients who are seropositive for NMO‐IgG are at high risk for relapse. Ann Neurol 2006
Polymere Therapeutika: Konzepte und Anwendungen
Authors: Haag Rainer , Kratz Felix
Published: January 2006

Polymere Therapeutika umfassen Polymer‐Protein‐Konjugate, Wirkstoff‐Polymer‐Konjugate und supramolekulare Wirkstofftransportsysteme. Zahlreiche Polymer‐Protein‐Konjugate mit verbesserter Stabilität und Pharmakokinetik wurden z. B. durch Anknüpfen einer Polyethylenglycolkomponte (PEGylierung) an Enzyme oder therapeutisch relevante Proteine entwickelt. Einige davon sind bereits als Medikamente zugelassen, z. B. die PEGylierte Form der Adenosin‐Desaminase. Die Kupplung von niedermolekularen Cytostatika an hochmolekulare Polymere durch einen spaltbaren Linker ist eine effektive Methode zur Verbesserung des therapeutischen Index klinischer Wirkstoffe, und erste Kandidaten wurden bereits klinisch evaluiert, darunter N‐(2‐Hydroxypropyl)methacrylamid‐Konjugate von Doxorubicin, Paclitaxel und Platin(II)‐Komplexen. Zu einem weiteren Typ polymerer Therapeutika, den Wirkstofftransportsystemen, führte der Fortschritt bei definierten multivalenten und dendritischen Polymeren. Beispiele sind polyanionische Polymere als Inhibitoren der zellulären Bindung von Viren, polykationische Komplexe mit DNA oder RNA (Polyplexe) und dendritische Kern‐Schale‐Partikel zur Verkapselung von Wirkstoffen. In diesem Aufsatz geben wir einen Überblick über polymere Therapeutika mit einem Schwerpunkt auf Konzepten und Beispielen, die die besonderen Merkmale des jeweiligen Wirkstofftransportsystems charakterisieren.
Cover Picture: Transcription and Amplification of Molecular Chirality to Oppositely Biased Supramolecular π Helices (Angew. Chem. Int. Ed. 7/2006)
Authors: Ajayaghosh Ayyappanpillai , Varghese Reji , George Subi Jacob , Vijayakumar Chakkooth
Published: January 2006

Inversion of helicity and the formation of unusual fused supercoiled left and right helices of gel‐forming linear π‐conjugated molecules by a “sergeants and soldiers” approach, in which the achiral molecules (soldiers) mistake orders from the chiral molecules (sergeants), is described by A. Ajayaghosh et al. on page 1141 ff. The cover picture shows Janus, the double‐faced Greek God, holding a left‐handed DNA helix and a right‐handed conch which epitomize the marvels of natural creations.
Local thermal degradation behavior of heterophasic polypropylene copolymers
Authors: Manabe Norio , Yokota Yoshimitsu , Nakatani Hisayuki , Suzuki Shoutarou , Liu Boping , Terano Minoru
Published: January 2006

Polypropylene (PP) impact copolymer is one of the heterophasic PP systems that is improved by rubber modification. Because the copolymer is a complicated polymer blend, which mainly consists of PP and ethylene–propylene rubber (EPR) components, the degradation behavior has hardly been studied. In this study, the thermal degradation of the copolymer was studied through direct observation by atomic force microscopy, which is a powerful tool for observing a local domain in a polymer blend. The degradation behavior was visually captured by the mapping of topological changes. Although the EPR phase was hardly degraded, the neighboring PP matrix was degraded selectively. The degradation behavior of the copolymer was found to be heterogeneous. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 100: 1831–1835, 2006
Characterization of the aging behavior of raw epoxidized natural rubber with a rubber processing analyzer
Authors: Wang Ping‐Yue , Qian Hong‐Lian , Yang Chun‐Liang , Ying‐Chen
Published: January 2006

Tests of the strain sweep, frequency sweep, and stress relaxation for raw epoxidized natural rubber were carried out with a rubber processing analyzer. The results showed that the complex viscosity, η*, decreased with the prolongation of the aging time in the region of Newtonian flow, but in the region of non‐Newtonian flow, the decrement of η* with a rising shear rate decreased with the prolongation of the aging time. The torque (S′) response from the strain sweep indicated that aging brought about an obvious decrease in the increment of S′ with rising strain in the linear viscoelastic region and a small increase in the slope of the plateau on the curve of the S′ response in the nonlinear viscoelastic region. The stress relaxation rate constants k and b, calculated according to the equations St = S0e−kt and St = S1t−b (where St, S0, and S1 are the stresses at relaxation time t, t = 0, and t = 1, respectively), increased, and the stress relaxation time obtained directly from the rubber processing analyzer shortened with the prolongation of the aging time. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 100: 1277–1281, 2006
Copolymerization of two new kinds of methacrylate monomers and determination of monomer reactivity ratios
Authors: Erol Ibrahim
Published: January 2006

New methacrylate monomers 2‐(p‐methoxyphenoxy)‐2‐oxo‐ethyl methacrylate (pMPOEMA), 2‐(p‐chlorophenoxy)‐2‐oxo‐ethyl methacrylate (pClPOEMA), and 2‐oxo‐2‐phenylamino ethylene methacrylate (PAMA) were synthesized for the first time. The free‐radical‐initiated copolymerization of pMPOEMA and pClPOEMA with PAMA was carried out in 1,4‐dioxane solution at 65°C using 2,2′‐azobisisobutyronitrile (AIBN) as an initiator with different monomer‐to‐monomer ratios in the feed. The monomers and copolymers were characterized by Fourier transform infrared, 1H and 13C NMR spectral studies. The copolymer compositions were evaluated from nitrogen content in polymers. The reactivity ratios of the monomers were determined by applying Fineman–Ross and Kelen–Tüdös methods. The analysis of reactivity ratios revealed that pMPOEMA and pClPOEMA are less reactive than PAMA is, and copolymers formed are statistically in nature. The molecular weights (Mw and Mn) and polydispersity index of the polymers were determined using gel permeation chromatography. Thermogravimetric analysis of the polymers reveals that the thermal stability of the copolymers increases with an increase in the mole fraction of pMPOEMA and pClPOEMA in the copolymers. Glass transition temperatures of the copolymers were found to decrease with an increase in the mole fraction of PAMA in the copolymers. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 100: 1864–1874, 2006
Nonisothermal crystallization kinetics and morphology of self‐seeded syndiotactic 1,2‐polybutadiene
Authors: Cai Jiali , Li Tao , Han Ying , Zhuang Yuanqi , Zhang Xuequan
Published: January 2006

Subsequent melting behavior after isothermal crystallization at different temperatures from the isotropic melt and nonisothermal crystallization kinetics and morphology of partially melting sPB were carried out by differential scanning calorimetry (DSC), polarized light microscopy (POM), respectively. Triple melting‐endothermic peaks were observed for the polymer first isothermally crystallized at temperatures ranging from 141 to 149°C, respectively, and then followed by cooling at 10°C/min to 70°C. Comparing with the nonisothermal crystallization from the isotropic melt, the nonisothermal crystallization for the partially melting sPB characterized the increased onset crystallization temperature, and the sizes of spherulites became smaller and more uniform. The Tobin, Avrami, Ozawa, and the combination of Avrami and Ozawa equations were applied to describe the kinetics of the nonisothermal process. Both of the Tobin and the Avrami crystallization rate parameters (KT and KA, respectively) were found to increase with increase in the cooling rate. The parameter F(T) for the combination of Avrami and Ozawa equations increases with increasing relative crystallinity. The Ziabicki's kinetic crytallizability index GZ for the partially melting sPB was found to be 3.14. The effective energy barrier Δϵ describing the nonisothermal crystallization of partially melting sPB was evaluated by the differential isoconversional method of Friedman and was found to increase with an increase in the relative crystallinity. At the same time, Hoffman‐Lauritzen parameters (U and Kg) are evaluated and analyzed from the nonisothermal crystallization data by the combination of isoconversional approach and Hoffman‐Lauritzen theory. The Kg value obtained from DSC technique was found to be in good agreement with that obtained from POM technique. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 100: 1479–1491, 2006
Pore structure of macroporous monolithic cryogels prepared from poly(vinyl alcohol)
Authors: Plieva Fatima M. , Karlsson Malin , Aguilar Maria‐Rosa , Gomez David , Mikhalovsky Sergey , Galaev Igor Yu. , Mattiasson Bo
Published: January 2006

Macroporous monolithic cryogels made from poly(vinyl alcohol) (PVA) with degree of saponification 87.7% have been prepared using a crosslinking reaction with glutaraldehyde under acidic conditions at subzero temperatures. The porous structure of the monolithic cryogels from PVA (cryoPVA), analyzed using optical microscopy, scanning electron microscopy, and environmental scanning electron microscopy, revealed interconnected macropores up to 150 μm in size with a noticeable microporosity of the gel walls. Differential scanning calorimetry measurement showed that more than 90% of the water in the cryoPVA monoliths was freezable water, while the amount of polymer bound water increased with increase in the polymer concentration in the cryoPVA sample. The swelling degree of cryoPVA depended on concentration of polymer in the initial reaction mixture and degree of crosslinking. The cryoPVA monoliths were elastic and spongy‐like materials that can be dried, stored in dried state, and re‐swelled when required. Derivatization of hydroxyl‐groups of the cryoPVA monolith allowed incorporation of required functionality. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 100: 1057–1066, 2006