Local reinvention of the CDC HIV prevention community planning initiative.

The Centers for Disease Control and Prevention (CDC), in coordination with 65 states, cities, and territories, implemented HIV prevention community planning beginning in 1994. This large scale innovation in public health planning has involved tens of thousands of professionals and community residents. Though a single case study, Michigan provides a strong test of the implementation of this national prevention planning model because of the state's decentralized approach to HIV prevention community planning involving several hundred residents. A decentralized approach to community planning promises to maximize participation and the sharing of leadership as well as obstacles to community planning. Here, the CDC Guidance for community planning is contrasted with empirical observation of implementation in Michigan. We conclude that the high expectations for a decentralized approach to HIV prevention community planning can be best achieved when a distinction is drawn between information-seeking tasks and decision-making tasks. We recommend that information-seeking tasks be centrally coordinated, and that decision-making tasks be decentralized, to most fully achieve the potential of HIV prevention community planning.

The role of nurse practitioners in research.

Research can be accomplished by NPs even in times of financial constraint. Planning becomes more important, and a group of clinicians working together will make a difference in making studies possible. The most important requirement is probably the need for utmost care in planning. Given that NPs are willing to undergo the effort and frustrations of meticulous planning, NPs can fill the gap in clinical research left by the concentration of studies at the molecular rather the patient level.

Intending to forget: the development of cognitive inhibition in directed forgetting.

The thesis of this research is that children's cognitive inhibition increases in efficiency with age over the middle childhood years, and this increasing efficiency contributes to developmental improvements in memory performance. To explore this thesis, the development of efficient retrieval inhibition, defined as the suppression of activation and retrieval paths to information stored in long-term memory, was investigated. In Experiment 1, first, third, and fifth graders and adults participated in a directed-forgetting experiment. Using a blocked-cuing procedure, subjects were given a "forget" or "remember" cue halfway through an unrelated free-recall list. At recall, subjects were asked either to remember all the words (even the ones they had been instructed to forget) or to remember only to-be-remembered words. The results suggested that the ability to intentionally inhibit the maintenance and recall of irrelevant information improves gradually over the elementary school years, but is not fully mature by fifth grade. Children were less able than adults to inhibit the to-be-forgotten words, and they were less able to withhold production of remembered to-be-forgotten words than were adults. Experiment 2 replicated the development effects found in the first experiment and demonstrated that the developmental differences in performance were due to differences in mnemonic processing rather than differences in the ability to understand the instructions of the tasks.

Need for HIV education among public health personnel in Michigan.

Knowledge and attitudes related to human immunodeficiency virus (HIV) and the use of the universal precautions recommended by the Centers for Disease Control and Prevention were investigated among 807 State and 2,797 local public health personnel in Michigan in September 1989. Survey results indicated that the majority of respondents were well-informed regarding the major routes of HIV transmission, but many respondents hold misconceptions regarding nonviable routes of transmission and about policies on HIV counseling and testing. Respondents reporting occupational exposure to blood or semen reported inconsistent use of universal precautions. Most respondents believed in providing the same quality of care for those with HIV infection as for noninfected persons. However, 32.4 percent believed that they should have the right to refuse treatment, and 9.4 percent reported that they would not be willing to provide routine public health services to an HIV-infected client. The results of this research suggest that in Michigan, public health personnel are in need of HIV education that focuses on the correction of misconceptions about HIV transmission, counseling, and testing policies; the development of appropriate attitudes toward persons infected with HIV; and the appropriate use of universal precautions. Findings also suggest that inadequate protective equipment is an important barrier to the consistent use of universal precautions.

Increasing the supply of cadaveric kidneys for transplantation.

The number of cadaveric kidneys currently available for transplantation is insufficient. Therefore, the Center for Disease Control (CDC) undertook a collaborative project with the two transplant programs in Georgia to increase te retrieval of cadaveric kidneys. We used retrospective analysis to select productive hospitals, hospital-specific surveillance systems to identify potential donors, and procurement and retrieval evaluation to identify preventable deficiencies. During 900 hospital months of prospective surveillance, we identified a total of 555 potential donors by death record review, giving a potential donor rate of 2.3 donors/100 deaths (110 kidneys/million population/year). We observed an increase in the number of referrals, consent obtained from next of kin, and kidneys retrieved. This period of intensive activity demonstrated that additional kidneys can be retrieved by using systematic methods.

Morphology of differentiating epithelial cells in the respiratory tract of the postnatal opossum (Didelphis virginiana).

Correlative microscopy of the developing respiratory epithelium during mucous cell differentiation reveals a decrease in the concentration of ciliated cells concomitant with proliferation of mucous cells and formation of an inner layer of the mucous blanket. Nonciliated cells increase in concentration between 40 and 80 days postnatal and provide the major surface area of the tracheal epithelium. Nonciliated cells change from isolated small patches with flat, finely-corrugated surfaces to larger, rounded aggregates with bulging cytoplasmic contents. Individual, nonadjacent ciliated cells are distributed around the borders of aggregates. By 120 days the precise boundary of each aggregate is lost as the epithelium develops more smooth contour. In the major bronchi, ciliated cells occur primarily in the clefts between bronchial folds. Cells in these clefts also provide for the origin of goblet cells, observed by 80 days and heavily concentrated here at 120 days. Nonciliated cells with smooth surfaces (dome cells) occupy the ridges of bronchial folds and their morphology varies little up to 120 days. A tannic acid technique was used to demonstrate the development of the inner layer of the mucous blanket. The layer begins as a thin fibrillar coat on the surface of the tracheal and bronchial epithelium at 40 days. It becomes progressively thicker in the trachea but changes little in the bronchi.