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The AMIA 2003 Spring Congress entitled "Bridging the Digital Divide: Informatics and Vulnerable Populations" convened 178 experts including medical informaticians, health care professionals, government leaders, policy makers, researchers, health care industry leaders, consumer advocates, and others specializing in health care provision to underserved populations. The primary objective of this working congress was to develop a framework for a national agenda in information and communication technology to enhance the health and health care of underserved populations. Discussions during four tracks addressed issues and trends in information and communication technologies for underserved populations, strategies learned from successful programs, evaluation methodologies for measuring the impact of informatics, and dissemination of information for replication of successful programs. Each track addressed current status, ideal state, barriers, strategies, and recommendations. Recommendations of the breakout sessions were summarized under the overarching themes of Policy, Funding, Research, and Education and Training. The general recommendations emphasized four key themes: revision in payment and reimbursement policies, integration of health care standards, partnerships as the key to success, and broad dissemination of findings including specific feedback to target populations and other key stakeholders.

A cross-sectional, correlational design was used to describe and explore the relation between caregiver sleep and depression. For the study, 51 caregivers were recruited from two sites in southern California. Caregivers were primarily white (84%), female (80%), spouses (61%), or adult children (29%), who had provided care for a mean of 16 hours per day for an average of 2 years. The Center for Epidemiological Studies-Depression (CES-D)and the Pittsburgh Sleep Quality Index (PSQI) were used to measure caregiver depression and sleep, respectively. Most of the caregivers (95%) expressed severe sleep problems, and more than half of them were experiencing depressive symptoms at a level that would suggest risk for clinical depression. Correlations were strongest between caregiver depression and the sleep subscales of overall quality (r = 0.70; p < 0.001), habitual sleep efficiency (r = 0.54; p < 0.001), and daytime dysfunction (r = 0.59; p < 0.001). The final regression model, which included these subscales, predicted 63.6% of the variance in depression scores (F = 27.32; p < 0.001). These findings, which are consistent with results from other studies, suggest that caregivers of persons with terminal illness are at risk for clinical depression. It is critical for nurses to be cognizant of the relation between sleep problems and depression, and to explore interventions that would allow the caregivers to obtain needed sleep without diminishing their ability to function in their role as caregiver.

The results suggest a plausible effectiveness of the C-B intervention in preventing the progression of depression. Suggestions for future research are provided.

Antiretroviral treatment nonadherence is complex, implicating more than a patient's ability and motivation to be compliant. The bulk of the research to date focuses on individual level barriers with less emphasis on the many system level factors that potentially impact patients' adherence behaviors. This study examined the effects of system enabling factors in addition to the frequently studied individual predisposing and enabling factors upon nonadherence to treatment. One hundred eighty-two patients from five community-based clinics were interviewed and their medical charts examined. Patients' self-reported nonadherence was correlated with clinicians' assessments of medication and appointment nonadherence. Seven individual predisposing factors (gender, ethnicity, birthplace, years of education, HIV Overview of Problems-Evaluation System [HOPES] psychosocial, Hospital Anxiety and Depression Scale [HADS] anxiety, and HADS depression scores) were found to be significantly associated with treatment adherence/nonadherence. Individual enabling factors (hopefulness and access to health care), as well as treatment by clinic staff, a system enabling factor, were significantly associated with adherence/nonadherence. In a multivariate analysis, six factors - age (younger), gender (female), birth outside the United States, level of hopefulness (lower), access to health care (lower), and treatment by clinic staff (poorer) - accounted for 19.3% of the variance in nonadherence. Results of this study indicated that several individual predisposing and enabling factors were potential predictors of treatment nonadherence; however, system enabling factors, e.g., treatment by clinic staff were also associated with treatment nonadherence. Further studies are needed to examine the complex relationships of individual and system related factors in predicting treatment nonadherence.

Hardened dichromated gelatin is the best material available today for the fabrication of holographic optical elements (HOEs) because of its low scattering, large refractive index modulation capacity, and other unique properties such as reprocessibility. On the basis of experimental data accumulated during the last several years, we describe holographic characteristics of the dichromated gelatin, including exposure characteristics with a bulk exposure model, hologram thickness change, and environmental stability. Basic chemistry, hologram formation in the dichromated gelatin, and generalized processing techniques are also discussed.

BackgroundThe number of patients with pulmonary disease caused by nontuberculous mycobacteria (NTM) has been increasing worldwide. The aim of this study was to evaluate long-term trends in the NTM recovery rate from respiratory specimens over a 10-year period in a tertiary referral hospital in South Korea.MethodsWe retrospectively reviewed the records of mycobacterial cultures of respiratory specimens at Samsung Medical Center from January 2001 to December 2011.ResultsDuring the study period, 32,841 respiratory specimens from 10,563 patients were found to be culture-positive for mycobacteria. These included 12,619 (38%) Mycobacterium tuberculosis and 20,222 (62%) NTM isolates. The proportion of NTM among all positive mycobacterial cultures increased from 43% (548/1,283) in 2001 to 70% (3,341/4,800) in 2011 (p<0.001, test for trend). The recovery rate of NTM isolates from acid-fast bacilli smear-positive specimens increased from 9% (38/417) in 2001 to 64% (1,284/1,997) in 2011 (p<0.001, test for trend). The proportion of positive liquid cultures was higher for NTM than for M. tuberculosis (p<0.001). The most frequently isolated NTM were Mycobacterium avium-intracellulare complex (53%) and Mycobacterium abscessus-massiliense complex (25%).ConclusionThe recovery rate of NTM from respiratory specimens in South Korea has increased steadily.

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