Introducing a new definition of a near fall: intra-rater and inter-rater reliability.

Near falls (NFs) are more frequent than falls, and may occur before falls, potentially predicting fall risk. As such, identification of a NF is important. We aimed to assess intra and inter-rater reliability of the traditional definition of a NF and to demonstrate the potential utility of a new definition. To this end, 10 older adults, 10 idiopathic elderly fallers, and 10 patients with Parkinson's disease (PD) walked in an obstacle course while wearing a safety harness. All walks were videotaped. Forty-nine video segments were extracted to create 2 clips each of 8.48 min. Four raters scored each event using the traditional definition and, two weeks later, using the new definition. A fifth rater used only the new definition. Intra-rater reliability was determined using Kappa (K) statistics and inter-rater reliability was determined using ICC. Using the traditional definition, three raters had poor intra-rater reliability (K<0.054, p>0.137) and one rater had moderate intra-rater reliability (K=0.624, p<0.001). With the traditional definition, inter-rater reliability between the four raters was moderate (ICC=0.667, p<0.001). In contrast, the new NF definition showed high intra-rater (K>0.601, p<0.001) and excellent inter-rater reliability (ICC=0.815, p<0.001). A priori, it is easy to distinguish falls from usual walking and NFs, but it is more challenging to distinguish NFs from obstacle negotiation and usual walking. Therefore, a more precise definition of NF is required. The results of the present study suggest that the proposed new definition increases intra and inter-rater reliability, a critical step for using NFs to quantify fall risk.

VCD configuration of enantiopure/-enriched tetrasubstituted alpha-fluoro cyclohexanones and their use for epoxidation of trans-olefins.

The configurations of three enantiopure tetrasubstituted alpha-fluoro cyclohexanones (-)-5Ia, (-)-5IIa and (-)-6a were determined by VCD and proved to be (-)-(2S,5R)-5Ia, (-)-(2R,5R)-5IIa, and (-)-(2R,5R)-6a. The VCD study also identified the conformers populated in CDCl3 solution, including higher-energy gas-phase conformers with equatorial fluorine for 5Ia and 5IIa that are stabilized in CDCl3 solution. Used as catalysts for epoxidation of trans olefins (beta-methylstyrene, stilbene, methyl p-methoxy cinnamate) by oxone, it was found that (-)-5Ia is the most efficient for all trans olefins (providing, respectively, 62%, 90% and 66% ee) but that all three ketones provide high ee% with stilbene (78-90% ee). Moreover, the configurations predicted from the stereo outcome of the epoxidation reaction are identical to those determined by VCD.

erythro-1-Naphthyl-1-(2-piperidyl)methanol: synthesis, resolution, NMR relative configuration, and VCD absolute configuration.

The erythro isomer of 1-naphthyl-1-(2-piperidyl)methanol 4, an efficient chiral modifier for asymmetric heterogeneous hydrogenation, was obtained as the major isomer (95%) in two steps while the threo isomer can be obtained as the major isomer (67%) in three steps. erythro-4 and threo-4 were resolved on a CHIRALCEL OD-RH column. It has been shown by VCD that the diastereomer determined as the erythro by NMR was indeed the erythro and that the first eluted (-)-enantiomer on CHIRALCEL OD-R or -RH columns has the (1R,2S) configuration. The VCD studies identify the presence of at least five conformers in CDCl(3) solution. Moreover, this (-)-(1R,2S) absolute configuration found by VCD is consistent with the expected stereo-outcome of catalytic hydrogenation of pyruvate into lactate, which supported the (+)-(1S,2R) assignment.

Hydrogen-stretching vibrational circular dichroism spectroscopy: absolute configuration and solution conformation of selected pharmaceutical molecules.

The vibrational circular dichroism (VCD) spectra of several chiral antiarrhythmic drugs (quinidine, flecainide, RAC 109, and propranolol) and chiral anti-inflammatory drugs (ibuprofen and naproxen) in the OH-, NH- and CH-stretching regions are reported. The absolute configurations of some of these drugs are identified by comparison to VCD spectra of similar molecules and by VCD intensity calculations on fragments of the drugs, utilizing either the locally distributed origin gauge (LDO) model or a priori vibronic coupling theory (VCT) methods. The most abundant conformations of propranolol, flecainide and RAC 109 in non-aqueous solution are also identified from the VCD spectra. This study demonstrates the utility of VCD in this spectral region for identification of solution conformation and absolute configuration for pharmaceuticals of moderate size. The conformations deduced from the VCD spectra provide insight into the stereospecific binding of the antiarrhythmic drugs.

Vibrational circular dichroism: an incisive tool for stereochemical applications.

Vibrational circular dichroism (VCD) is the extension of circular dichroism (CD) from electronic to vibrational transitions in molecules. In this review, we present the basic concepts of VCD and focus on its growing strength for stereochemical applications. There are three principal areas of application of VCD. These are the determination of optical purity, the determination of absolute configuration and the determination of conformational properties of chiral molecules in solution. Until recently, the application of VCD was restricted to the use of instruments that had been custom assembled in academic research laboratories. This situation has now changed. It is possible to purchase a dedicated Fourier transform infrared (FTIR) VCD spectrometer complete with user friendly software. Combined with rapid advances in the ab initio theoretical prediction of infrared (IR) and VCD spectra, the availability of such technology opens the way for the widespread use of VCD spectroscopy for research and industrial applications.

Genetic susceptibility testing: ethical and social quandaries.

Breast cancer in the United States continues to be a serious public health problem that affects individuals, families, and society. The simultaneous rapid progress in mapping the human genome, the advances in technology, and the subsequent commercialization of genetic testing have made it possible for women to seek breast and ovarian cancer susceptibility testing before comparable social and psychological supports are put in place. As health care places more emphasis on illness prevention and simultaneously commits less economic support for health care, genetic testing presents social and ethical challenges as well as dilemmas. The study discussed in this article consisted of intensive field observation and in-depth, face-to-face interviews concerning genetic susceptibility testing. The social worker may be in a unique position to collaborate with other health professionals in the clinical and the policy arena in regard to these tests.

"Why don't they come to Pike Street and ask us"?: Black American women's health concerns.

It is well known that black American women are poorly represented in medically oriented research and that this has far reaching implications for their personal health, the health of their families and the overall health of the larger society. The research reported was premised on the assumption that learning more about black American women's beliefs and values regarding health and illness could inform public policy initiatives in the area of cancer prevention and control so that a more equitable basis for participation could be achieved in future medical and scientific research. Qualitative methods of research were used in this investigation. A semi-structured interview guide was used in 36 h. of in-depth and face-to-face interviews with 13 black American women recruited to the study using a snowball technique. The women interviewed were middle-class, professional and semi-professional women. The results of the study indicate that there is a poor understanding by the dominant white medical community concerning the beliefs and values of black patients and that this compromises their health and illness care. The Tuskegee Syphilis Experiment is often used as the rationale for the low recruitment of black women into clinical trials both therapeutic and non-therapeutic. The women interviewed do not agree with this claim. These women suggest that if they were asked to participate in trials and the trial was relevant to their primary medical concerns they would consider joining. The research results indicate the importance of using specific research methodologies and a number of recommendations are presented.

The Breast Cancer Prevention Trial: nurses' observations.

The Breast Cancer Prevention Trial (BCPT), a case study of a clinical prevention trial, offered a unique opportunity to examine the multifaceted and complex role of the nurse. The primary aims of this study were (a) to identify the self-descriptions of a sample of nurses involved in the day-to-day management of the BCPT, (b) to determine the nurses' perceptions of their own role and the role of the women who joined the BCPT, (c) to understand the role of the nurse in the larger context of a clinical prevention trial, and (d) to expand the knowledge base regarding some of the social and ethical underpinnings of clinical prevention trials with healthy participants. The research design was qualitative, descriptive, and exploratory. The methods used were the telephone interview and the focus group. Fifty BCPT nurses were interviewed. This included 30 telephone interviews and 20 additional BCPT nurses who participated in four national and international focus groups. After analysis of the data using ethnographic methods, a view of the multi-faceted role of the BCPT nurse emerged. On a broader scale, the inquiry raised a number of critical ethical and social issues that are relevant to future clinical prevention trials with volunteer human participants.

A physical assay for meiotic recombination in Coprinus cinereus.

We have used the polymerase chain reaction (PCR) method to monitor meiotic recombination in the basidiomycete Coprinus cinereus. We used DNA-mediated transformation to recover strains with modifications of the trp1 locus. The modifications were designed to introduce unique PCR priming sites separated by a homologous 2.4 kb region in which crossing over could occur. We showed that exchange occurred in this region at the frequency expected for a typical region of this genome (2.4 kb should correspond to a genetic length of 0.08 cM). We also detected products resulting from crossing over in DNAs extracted from cells in meiotic prophase. The assay should be useful for monitoring exchange in mutants that cannot complete meiosis.

Vibrational optical activity of oligopeptides.

Vibrational optical activity (VOA) is a relatively new spectroscopic technique, which has two principal manifestations, ir vibrational CD and vibrational Raman optical activity. Progress in the study of oligopeptides using both of these forms of VOA is reviewed from the perspective of theoretical and instrumental techniques, spectral results, and structural interpretations.

Competencies for health management practice: a practitioner's perspective.

The current health care environment will require executive leadership with a new set of management competencies to effectively lead and manage the various components of a restructured health care delivery system. The traditional management skills of planning, organizing, directing, controlling, and staffing resources will remain relevant, but the true measure of professional success will be the development of conceptual skills. This means the ability to look at the health care enterprise as a whole, and recognize how changes in the environment shape your strategic mission, goals, and objectives. The successful health care leader will have a demonstrated ability to apply these conceptual skills to the development of information systems and integrated networks that position their organization to accept capitated risks. This paper examines the United States and Canadian health care systems from the perspective of both the more traditional hospital and the emerging medical care organizations. New importance of the team approach to leadership and management and all that entails is stressed.

Social and cultural dimensions of hair loss in women treated for breast cancer.

The chief goal of this exploratory study was to discover what a woman's own experience of her illness meant to her--how she thinks of herself as a woman and a person with a health problem. The study was exploratory in nature and designed to expand our conceptual thinking about health and illness and the delivery of health-care services. The study was qualitative, and the principal method was the semi-structured, indepth, face-to-face interview. All of the women in the study had been diagnosed with primary breast cancer and were in a variety of stages of treatment. What emerged from the study were explanatory stories that women constructed to chronicle their illness experience and interpret it. The theme under discussion here is hair loss as symbolic of larger cultural beliefs and values. Recommendations for interventions with women who experience hair loss as a traumatic event are offered in the context of a deeper cultural understanding of hair loss that is a consequence of cancer care.

Mount Sinai Hospital's journey into TQM.

Toronto's Mount Sinai Hospital commenced its total quality management journey in the late 1980s as a complement to its extensive experience in quality assurance. This article focuses on Phase I--the process of setting up teams. This phase includes project nomination and selection; team membership selection and education; and the quality improvement process. The authors share the lessons they learned during the course of the journey and present the directions that TQM at Mount Sinai will take in the future.

Comparison of IR and Raman forms of vibrational optical activity.

Natural vibrational optical activity consists of two principal forms. The IR form is known as vibrational circular dichroism (VCD) and is simply the extension of electronic circular dichroism into the IR vibrational region of the spectrum. The Raman form, known as Raman optical activity (ROA), is a new form of optical activity that has no counterpart in the classical forms of optical activity. In this paper, the similarities and differences of the IR and Raman forms of vibrational optical activity will be examined. Although both VCD and ROA were discovered and confirmed in the period from 1973 to 1975, each field has evolved independently with key advances in theoretical description, instrumentation and application coming at different times over the past 20 years. The current relative strengths and weaknesses of VCD and ROA will be discussed, and specific examples of VOA spectra of (-)-alpha-pinene and the amino acid L-alanine, for which overlapping VCD and ROA data are available, will be presented.

Vibrational circular dichroism in ephedra molecules. Experimental measurement and ab initio calculation.

Vibrational circular dichroism (VCD) spectra in the OH- and NH-stretching regions have been measured for six pharmaceutical molecules in the ephedra class, (1S,2R)-norephedrine, (1), (1S,2S)-norpseudoephedrine (2), (1S,2R)-ephedrine (3), (1S,2S)-pseudoephedrine (4), (1S,2R)-N-methylephedrine (5) and (1S,2S)-N-methylpseudoephedrine (6), all in dilute C2Cl4 solution. Ab initio calculations of geometries and vibrational frequencies for a number of conformers of 1 to 6 have been carried out. The recently developed locally distributed origin gauge model for VCD was used to calculate VCD spectra of the conformers for each drug. This ground-state ab initio model, which does not require sum-over-states, magnetic field perturbation or localized molecular orbitals, has been found to give good agreement with experiment in this frequency region. Composite spectra obtained from weighted averages of the calculated conformer spectra agree within a factor of two with observed IR and VCD intensities for five of the ephedra drugs. For (1S,2S)-pseudoephedrine, the discrepancy between experiment and calculation has been interpreted in terms of a coupled-oscillator effect absent in the other molecules.

De novo methylation of repeated sequences in Coprinus cinereus.

We have examined the stability of duplicated DNA sequences in the sexual phase of the life cycle of the basidiomycete fungus, Coprinus cinereus. We observed premeiotic de novo methylation in haploid nuclei containing either a triplication, a tandem duplication, or an ectopic duplication. Methylation changes were not observed in unique sequences. Repeated sequences underwent methylation changes during the dikaryotic stage. In one cross, 27% of the segregants exhibited methylation-directed gene inactivation. However, all auxotrophs eventually reverted to prototrophy. C to T transition mutation were not observed in this study. Our studies also revealed one inversion that occurred in 50% of the segregants in a single triplication cross, and a single pop-out event that occurred during vegetative growth. These alterations were similar to changes reported in experiments with duplicated sequences in Neurospora crassa and Ascobolus immersus. However, significant differences were also noted. First, the extent of methylation was much less in C. cinereus than in the other two fungi. Second, CpG sequences appeared to be the preferred targets of methylation.