The Indigent Care Collaboration (ICC), a partnership of Austin, Texas, safety net providers, gathers encounter data and manages initiatives for the community's medically indigent patients. One such initiative is the establishment of a care management program designed to reduce avoidable hospitalizations. This study developed predictive models designed to take year-one encounter data and predict inpatient utilization in the following two years. The models were calibrated using 2003 through 2005 data for the 41,260 patients with encounters with ICC partner providers in all three years. Predictor variables included prior inpatient admissions, age, sex, and a summary measure of overall health status: the relative risk score produced by the Diagnostic Cost Groups prospective Medicaid risk-adjustment model. Using the 44,738 patients with encounter data in each of years 2004 through 2006 data, the performance of the predictive models was cross-validated and compared against the performance of the "common sense" method of choosing candidate patients based on prior year chronic disease diagnoses and high utilization, referred to herein as the Utilization Method (UM). The 620 patients with three or more 2005 through 2006 inpatient admissions were considered the actual high use patient subset. Each model's highest-risk 620 patients comprised its high-risk subset. Only 344 high-risk patients met the UM’s criteria. Prediction accuracy was described in terms of positive predictive value (PPV), i.e., the proportion of identified high-risk patients who were high-use patients. Three of the predictive models had a PPV of near 25% or greater, with the highest, the linear model using the DCG relative risk score, at 26.8%. The PPV of the UM was 17.1%, lower than that of all predictive models. When all high-risk subsets were limited to 344 patients (the number identified by the UM), the performance of the UM and the predictive models was similar. This study demonstrated that “common sense” targets for case management can be identified via simple filter as effectively as through empirically-based predictive models. However, once the supply of easily identifiable targets is exhausted, predictive models using a measure of health status identify high-risk patients who could not be easily identified by other means. / text

Structured RNAs are pervasive in biology, spanning a functional repertoire that includes messengers, regulators of gene expression and catalysts of translation and splicing. From the relatively simple tRNAs and riboswitches to the highly structured ribosomal RNAs, the ability of RNAs to function is dependent on well-defined secondary and tertiary structures. However, studies of RNA folding in vitro have revealed an extreme propensity to form alternative structures, which can be long-lived and interfere with function. In the cell, a diverse array of RNA binding proteins and RNA chaperones guide RNAs towards the correct structure and disrupt misfolded intermediates. Among these proteins, DEAD-box protein family stands out as one of the largest groups, with its members ubiquitously involved in RNA metabolism across all domains of life. DEAD-box proteins can function as both specific and general RNA chaperones by disrupting RNA structures in an ATP-dependent manner. Here I describe my work studying the general RNA chaperone mechanism of the Neurospora crassa protein CYT-19, a model DEAD-box protein and a biological RNA chaperone that is required for efficient folding of self-splicing group I intron RNAs in vivo. After an introduction to DEAD-box proteins and their mechanisms as RNA remodelers (Chapter 1), I will first describe studies of group I intron unfolding by CYT-19, focusing on the effects of RNA tertiary structure stability on CYT-19 activity and targeting to RNA substrates (Chapter 2). I will then describe the characterization of ATP-dependent mechanisms during CYT-19-mediated refolding of the misfolded group I intron (Chapter 3). In Chapter 4, I will present small-angle X-ray scattering (SAXS) studies of structural features of DEAD-box proteins that allow them to efficiently interact with large structured RNA substrates. Finally, I will turn to studies of DEAD-box protein involvement during early steps of RNA compaction and folding, using SAXS and activity-based approaches (Chapter 5). I will conclude with a general discussion of superfamily 2 RNA helicases, which include DEAD-box and related proteins, and their functions and mechanisms as remodelers of structured RNAs and RNPs. / text

No description available.

No description available.

Monensin was fed at levels of 0 and 33 ppm in a series of experiments to determine its effect on nitrogen (N) utilization by steers fed diets high in sorghum grain (76%, steam-processed, flaked) and corn (90%, whole shelled). Total ruminal volatile fatty acid (VFA) concentrations measured 3 hr postprandially were not affected by monensin addition to either diet. Molar proportion of acetic acid decreased (P < .05) was observed with monensin addition to the sorghum grain-based diet. Monensin had no effect on apparent total tract digestibility of dry matter or energy in either diet, but consistently improved apparent total tract digestibility of crude protein (CP) in both diets. Improvement was greater (P < .05). Retention of N tended (P > .05) to improve in response to monensin with the sorghum grain-based diet (24 vs 20% of N intake; 41 vs 36% of N absorbed). Ruminal ammonia concentrations measured 3 hr post-prandially were decreased (P < .10) ruminal digestion of feed N (44 vs 51%) for steers fed monensin. Monensin decreased (P < .05) the contibution of bacterial N (42 vs 50%) and increased (P < .05) that of ruminally undegraded feed (bypass) N (58 vs 50%) to total N digested postruminally, resulting in less (P < .10) bacterial N (23 vs 28 g/day) and a tendency (P > .10) for more feed bypass N (32 vs 27 g/day) to be digested in the intestines of steers fed monensin with the corn-based diet. That monensin caused a greater proportion of feed OM and N to be digested and absorbed in the intestines than in the rumen (with possibly greater resultant metabolic efficiency) may account for some of the benefit of feeding this compound with high grain diets, as losses incurred in the ruminal transformation of feed nitrogen to bacterial nitrogen appear to be partially eliminated.

No description available.

The intent of this study was to examine the perceived resources and obstacles which were related to the utilization of mental health services by chronically mentally ill Mexican American clients. Specifically, the study identified resources and obstacles encountered by six chronically mentally ill clients and six family members as they accessed various mental health services. The study was conducted in the fall of 1985 from clients currently receiving services from La Frontera Center, Inc., Tucson, Arizona. Data were interpreted through content analysis to conceptualize and categorize client and family member responses. Chronically mentally ill clients relied heavily on individuals such as friends, therapist and priest as resources for mental health service support. In contrast, family members focused primarily on institutions for resource support. Financial resources, institutional policies, denial, and the lack of personal direction were listed as obstacles to seeking mental health services by clients and family members. Study results suggested that the perceptions of traditional and nontraditional obstacles and resources by Mexican American clients and family members continue to strongly influence utilization of mental health services In particular, the issue of "stigma" and the personal qualities and abilities of the therapist emerged as significant descriptors in client and family member self statements.

No description available.

The present study examines the issue of minority participation in a multi-faceted prevention program for youth with problem behavior. Historically, participation in such research programs has been low (Myers, Alvy, Richardson, Arrington, Marigna, Huff, Main, & Newcomb, 1990; Coie, 1996; Spoth & Redmond, 2001). Targeted prevention programs, which design their interventions for populations that are susceptible to negative outcomes, face more obstacles to participation than most participants of universal prevention programs. Targeted populations, specifically families with children with problem behavior, are usually under great duress, suffer multiple hardships, and have high adversity characteristics, (e.g., low socioeconomic status, insularity, single-parent families, and low levels of education). As has long been documented, minority status is usually associated with this heightened risk status (Prinz & Miller, 1991). A common suggestion in the prevention and therapeutic treatment literature is the use of minority staff members to increase the likelihood of participation of minority parents (Prinz, Smith, Dumas, Laughlin, White & Barron, 2001). This argument is most prevalent in the literature regarding Latino clients (Sue, Fujino, Hu, Takeuchi, & Zane, 1991). This study attempts to predict minority parents' participation quality (PQ) from demographic variables (e.g., level of adversity, ethnicity), participation rate (PR) (e.g., amount of participation measured by minutes and contacts), and ethnic matching. This study also offers insight on how PQ and PR relate to one another. The results of this study imply that PQ and PR relate differently for Latino parents than they do for parents from other ethnicities. The relationship of these variables has implications for frequency of dosages in an intervention, especially for interventions that attempt to reach distinct populations.

This study examines the elements of collaborative research partnerships (CRPs) between university researchers and other organizations or individuals in the education sector whose mandate is to conduct and disseminate research for service delivery. Studying these partnerships for knowledge mobilization(KMb)includes understanding the roles partners take on; the tensions or facilitators they face when bringing research into practice; the structures to maintain the partnership; and the knowledge mobilization activities. Phase 1 takes an in-depth look at one partnership using key informant interviews and document analysis, while phase 2 utilizes a survey between four overarching university-community organization partnerships across Canada. Findings suggest that although difficult, when research producers and users work together, capacity is built at the organizational level to view research evidence as an important part of the organizational service delivery, with small impacts on individual knowledge development; that partnerships remain informal in their practice; that the mechanisms by which partners use to communicate within the partnership and the frequency of communication helps to build relationships between partners; and the ideal type of CRP, where they ought to always be an equal endeavour, is overstated in the literature. Not all useful partnerships are exact equal contributions from research producers and their user-based partners. Implications include that researchers gain access to practice expertise and insights into practice-based research rather than engaging in only theoretical research while community partners gain access to greater capacity for understanding and using research through exchanges with academics.