Challenges and Solutions in Evaluation Technical Assistance During Design and Early Implementation.

This case study discusses two federal grant initiatives and the evaluation technical assistance (ETA) provided to the grantees. One program is a multiphase program funded by the Children's Bureau (CB) within the U.S. Department of Health and Human Services, Administration for Children and Families. The program funded communities interested in preventing homelessness among youth and young adults with child welfare histories. The funder, grantees, and ETA provider call it Youth At-Risk of Homelessness (YARH). Six federal agencies-the U.S. Departments of Education, Health and Human Services, and Labor, the Corporation for National and Community Service, and the Institute for Museum and Library Services-supported the second initiative known as Performance Partnership Pilots for Disconnected Youth (P3). We discuss the programs together as they share common features including a focus on building evidence, a focus on disconnected youth, use of liaisons to work with grantees who are developing interventions and planning or conducting evaluations at the same time, and having the same liaisons provide ETA to both the grantee/service providing group and the local evaluator. The article discusses (1) the grant programs, (2) details about ETA including its funding and provision, (3) details about the success and utilization of ETA, (4) benefits of ETA, and (5) balancing program or initiative requirements and evaluation needs and concludes with (6) thoughts on how to make ETA successful.

Proton pump inhibitors and histamine-2-receptor antagonists and pancreatic cancer risk: a nested case-control study.

BACKGROUND: The relationship between use of proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H(2)RAs) and pancreatic cancer risk has yet to be examined. Data from a range of studies suggest biologically plausible mechanisms, whereby these drugs (or the conditions for which they are prescribed) may affect pancreatic cancer risk. The objective of this study was to investigate the relationship between use of PPIs/H(2)RAs and pancreatic cancer risk. METHODS: A nested case-control study was conducted within the UK general practice research database (GPRD). Cases had a diagnosis of exocrine pancreatic cancer and controls were matched to cases on general practice site, sex and year of birth. Exposure to PPIs and to H(2)RAs since entry into GPRD until 2 years before the diagnosis date (corresponding date in controls) and in the 5 years before the diagnosis date were separately assessed. Conditional logistic regression analyses were used to generate odds ratios (ORs) and 95% confidence intervals (CIs) associated with PPI or H(2)RA use compared with nonuse. RESULTS: Ever use of PPIs since entry into the GPRD (excluding the 2 years prior to diagnosis) was not associated with risk of pancreatic cancer; OR (95% CI) 1.02 (0.85-1.22). Neither the dose nor the duration of PPI or H(2)RA use was associated with pancreatic cancer risk. No consistent patterns of association were seen when cumulative exposure (dose and duration) to these drugs was examined separately or together. CONCLUSION: PPI/H(2)RA use, in a UK population, was not associated with pancreatic cancer risk.

Non-steroidal anti-inflammatory drugs and pancreatic cancer risk: a nested case-control study.

BACKGROUND: Non-steroidal anti-inflammatory drug (NSAID) use has been linked with pancreatic cancer risk; however, findings from epidemiological studies are inconsistent. METHODS: A nested case-control study was conducted within the UK General Practice Research Database. Cases (n=1141) had a diagnosis of primary cancer of the exocrine pancreas between January 1995 and June 2006. Controls (n=7954) were matched with each case on general practice site, sex and year of birth. Conditional logistic regression analyses were used to generate odds ratios (OR) and 95% confidence intervals (CI) associated with NSAID use compared with non-use. RESULTS: Any use of NSAID in the 5 years before the index date or since entry into the database (excluding the year before diagnosis) was not associated with risk of pancreatic cancer; OR 0.96 (95% CI, 0.84-1.10) and 1.03 (95% CI 0.89-1.19), respectively. Exposure to NSAIDs for > 773 days, in the 5 years pre-diagnosis, was associated with a reduced risk of pancreatic cancer OR 0.78 (95%CI 0.62-0.97). There was evidence of reduced pancreatic cancer risk with long-term use (5 years or more) of lower doses of NSAIDs OR 0.70 (95% CI 0.49-0.99). CONCLUSION: Long-term exposure to NSAIDs may be associated with a reduction in risk of pancreatic cancer.

Antifungal susceptibilities and genetic relatedness of serial Trichophyton rubrum isolates from patients with onychomycosis of the toenail.

Onychomycosis is a common fungal disease infecting up to 20% of the population over age 40. The major causative agent of onychomycosis is Trichophyton rubrum. Uncontrolled infection may eventually lead to penetration of the newly forming nail plate. In spite of the encouraging cure rate with recent antifungal agents such as the allylamines (terbinafine) and azoles (itraconazole and fluconazole) some patients inevitably fail therapy. In this investigation, a group of patients from a multi-center study designed to assess the efficacy of terbinafine with known cases of onychomycosis were selected for evaluation. Nail samples from this patient group were colonized with T. rubrum throughout the terbinafine therapy. Antifungal susceptibility testing was performed on these T. rubrum isolates to detect change in MIC values. Strain relatedness was examined using random amplified polymorphic DNA (RAPD) technique. Our results revealed failure of patients to clear T. rubrum is not related to the development of resistance to the drug. While species determination was possible, we were not able to identify differences that would indicate reinfection with a new strain. Analysis of patient demographic data revealed that 70% of patients were over 45 years old, 56.6% were previously treated with antifungals, 60% came from family history with onychomycosis and 13% were diabetic. In conclusion, our data indicate that patients' failure to clear onychomycosis was not associated with resistant development. Failure of terbinafine therapy may be dependent on host-related factors.

Antifungal susceptibilities and genetic relatedness of serial Trichophyton rubrum isolates from patients with onychomycosis of the toenail.

Onychomycosis is a common fungal disease infecting up to 20% of the population over age 40. The major causative agent of onychomycosis is Trichophyton rubrum. Uncontrolled infection may eventually lead to penetration of the newly forming nail plate. In spite of the encouraging cure rate with recent antifungal agents such as the allylamines (terbinafine) and azoles (itraconazole and fluconazole) some patients inevitably fail therapy. In this investigation, a group of patients from a multi-center study designed to assess the efficacy of terbinafine with known cases of onychomycosis were selected for evaluation. Nail samples from this patient group were colonized with T. rubrum throughout the terbinafine therapy. Antifungal susceptibility testing was performed on these T. rubrum isolates to detect change in MIC values. Strain relatedness was examined using random amplified polymorphic DNA (RAPD) technique. Our results revealed failure of patients to clear T. rubrum is not related to the development of resistance to the drug. While species determination was possible, we were not able to identify differences that would indicate reinfection with a new strain. Analysis of patient demographic data revealed that 70% of patients were over 45 years old, 56.6% were previously treated with antifungals, 60% came from family history with onychomycosis and 13 % were diabetic. In conclusion, our data indicate that patients' failure to clear onychomycosis was not associated with resistant development. Failure of terbinafine therapy may be dependent on host-related factors.

Methanol poisoning: a review and case study of four patients from central Australia.

Methanol intoxication, a rare and potentially lethal form of poisoning, usually results from ingestion and occasionally inhalation of methanol. Initial symptoms of blurred vision, elongated anion gap and metabolic acidosis are typically delayed and may not at first be recognised as methanol-related complaints. Once diagnosed, treatment must be prompt and definitive. As well as general supportive care, ethanol infusion, dialysis and alkalinization from the mainstays of treatment. The cases described in this paper are compared to previous reports from other countries worldwide and contrast the variance in outcome often seen in methanol poisoning. The paper describes two tragic deaths and two lucky survivors, all of whom had consumed a cocktail of methanol and other alcoholic beverages at the same party. The ICU nurse's role in managing the methanol-intoxicated patient relies on that person's sound knowledge of the unusual biochemical reactions occurring in the body and the need to institute definitive and supportive measures to help both patient and family recover.

Freeze-dried Chlorella vulgaris as food for Daphnia magna Straus in toxicity testing.

The continuous culture of fresh green algae for use as food for Daphnia magna in toxicity tests is labor intensive. The possibility of using freeze-dried Chlorella vulgaris as an off-the-shelf food was investigated. The performance of D. magna provided with freeze-dried food was investigated over several generations and was found to satisfy the current EC validity criteria. However, a number of life-history parameters, for example, fecundity and neonate size, were significantly reduced when compared to animals fed fresh algae. The effect of freeze drying on cell size and availability are investigated and discussed in relation to daphnid performance.

Variation in the development of cadmium resistance in Daphnia magna straus; effect of temperature, nutrition, age and genotype.

The extent to which responses to toxicants can be modified by the environment and genotype of Daphnia magna is important for interpreting the results from ecotoxicity tests. Variation in the development of cadmium resistance and its relevance for survivorship has been investigated in two genetically distinct clones of D. magna. Cadmium resistance was induced by pre-exposing daphnids to a sublethal concentration of a Cd/Zn mixture and thereafter cadmium tolerance was assessed in standard acute tests. The results showed that the ability to develop cadmium resistance is affected by temperature, but there is no consistent pattern for maternal nutrition. The age of the daphnids had no apparent effect on the development of cadmium resistance. Differences in the induction of cadmium resistance between clones were seen only under resource depression.

Induction of cadmium tolerance in two clones of Daphnia magna straus.

1. The abilities of two different genotypes of Daphnia magna to develop cadmium resistance through physiological adaptation, after pre-exposure to sublethal concentrations of Cd, Zn and Cd/Zn mixtures, was investigated. 2. The induced elevation in cadmium tolerance was shown to be associated with an increase in the body concentration of metallothionein-like proteins. 3. The highly significant difference in acute responses to cadmium between the two clones reduced after pre-exposure. 4. Differences in cadmium tolerance were shown to be associated with differences in cadmium uptake.

Energy allocation in the cladoceran Daphnia magna Straus, under starvation and refeeding.

Models incorporating the energetics of individual daphnids (Cladocera) have been developed to predict the effect of environmental variables, particularly food availability, on population dynamics. One of them, that of Kooijman (1986), assumes that all assimilated energy enters a storage compartment prior to use in production and metabolism, and that under starvation the stores are used to support maintenance, reproduction and somatic growth, in that order of priority. This predicts that, under starvation, reproduction and growth will continue for a time, and that after they cease death will be immediate. Another model, that of McCauley et al. (1990), assumes that assimilated energy is used directly for maintenance and production, and that stores are accumulated to support maintenance metabolism under starvation. This predicts that growth and reproduction should cease immediately upon starvation and that death will not be immediate. We have carried out laboratory experiments, manipulating starvation time, on Daphnia magna to distinguish between these two models. The results support features of both models in that reproduction, but not growth, ceases upon starvation. We therefore developed a third model in which both maintenance and growth are supported from stores under starvation, with maintenance taking priority over growth under these conditions.

GPs and consultants: is there agreement on patient management?

General practitioner attitude questionnaires were sent in May 1987 to 525 general practitioners (GPs) within Avon. A year later a section dealing with the management of clinical situations was sent to 198 Avon consultants, to determine how they would ideally expect a GP to respond to these situations. The majority of both the GPs and consultants held a common viewpoint, but significant differences were noted between the consultants and GPs in six out of the ten situations. Consultants with more than six months' GP experience had fewer significantly different views than their colleagues with little or no GP experience. GPs and specialists under the age of 45 years also had fewer significant differences in management than older GPs and specialists. The differences seem to reflect the clinical focus and interests of each professional group. We believe vocational training is a contributory factor to the differences and support the General Medical Council's proposal of a broader post registration training for all doctors.