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Biomedical subjects

K Jacobs

Publications and source records attributed to K Jacobs.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

A reforming accountability: GPs and health reform in New Zealand.

Over the last ten years or so, many countries have undertaken public sector reforms. As a result of these changes, accounting has come to play a more important role. However, many of the studies have only discussed the reforms at a conceptual level and have failed to study how the reforms have been implemented and operated in practice. Based on the work of Lipsky (1980) and Gorz (1989), it can be argued that those affected by the reforms have a strong incentive to subvert the reforms. This prediction is explored via a case study of general practitioner (GP) response to the New Zealand health reforms. The creation of Independent Practice Associations (IPAs) allowed the State to impose contractual-accountability and to cap their budget exposure for subsidies. From the GP's perspective, the IPAs absorbed the changes initiated by the State, and managed the contracting, accounting and budgetary administration responsibilities that were created. This allowed individual GPs to continue practising as before and provided some collective protection against the threat of state intrusion into GP autonomy. The creation of IPAs also provided a new way to manage the professional/financial tension, the contradiction between the professional motivation noted by Gorz (1989) and the need to earn a living.

Budgets↗
PubMedDate not supplied

The management of health care: a model of control.

This paper is aimed primarily at those involved in managing and implementing management structures in health services. It is concerned with the replacement of historical management structures with 'proven' private sector structures. It is argued that a major problem with the private sector models introduced in New Zealand is that they fail to recognise the levels of uncertainty inherent in the diagnosis and treatment of illness. The Gibbs Report criticisms of existing management practices are discussed, criticisms that were based strongly on the Griffiths Report. A model of organisational control is outlined, based on Ouchi's concepts of market, bureaucracy and clan. This model is used to evaluate two major structural changes: the introduction of general management and the involvement of clinicians in clinical directorates. It is argued that success or failure of health service management reform depends on a greater recognition of the underlying uncertainties involved in medical practice.

Health Care Reform↗
PubMedDate not supplied

Retrospective radon assessment by means of 210Po activity measurements.

A method for retrospectively assessing the average radon concentration in a dwelling, for a period as long as 40 years or more, is described. It is based on the free penetration of radon gas into bulky spongy materials called volume traps, and subsequent trapping of radon decay products inside them. This leads to a build-up of 210Pb, a radon decay product with a half life of 22.3 years, which reaches an equilibrium with the alpha emitter 210Po, indicative of the average radon concentration over the exposure period. The stuffing of mattresses, chairs, cushions, etc. can be considered a good volume trap. A chemical separation procedure is described, transforming the volume trap into a 210Po alpha source, whose activity is determined through alpha spectroscopy. The technique has been applied in over 300 samples, retrieved from dwellings in Serbia, Germany, Norway and Sweden. The technique has proven to be very robust and reproducible. In cases where radon data were available during the exposure period of the volume trap, a remarkable agreement was found. The best volume traps appeared to be polyester sponges found in many stuffings. The major drawback is the destructive nature of the method, its major advantage is the direct relationship between the radon gas and the 210Po signal. The technique can be useful in epidemiological studies of the lung cancer risk from indoor radon, for assessing the long term radon exposure.

Air Pollutants, Radioactive↗
PubMedDate not supplied

Isolation and characterization of genomic and cDNA clones of human erythropoietin.

The glycoprotein hormone erythropoietin regulates the level of oxygen in the blood by modulating the number of circulating erythrocytes, and is produced in the kidney or liver of adult and the liver of fetal or neonatal mammals. Neither the precise cell types that produce erythropoietin nor the mechanisms by which the same or different cells measure the circulating oxygen concentration and consequently regulate erythropoietin production are known. Cells responsive to erythropoietin have been identified in the adult bone marrow, fetal liver or adult spleen. In cultures of erythropoietic progenitors, erythropoietin stimulates proliferation and differentiation to more mature red blood cells. Detailed molecular studies have been hampered, however, by the impurity and heterogeneity of target cell populations and the difficulty of obtaining significant quantities of the purified hormone. Highly purified erythropoietin may be useful in the treatment of various forms of anaemia, particularly in chronic renal failure. Here we describe the cloning of the human erythropoietin gene and the expression of an erythropoietin cDNA clone in a transient mammalian expression system to yield a secreted product with biological activity.

Amino Acid Sequence↗
PubMedDate not supplied

A ruptured gastrointestinal stromal tumour of the transverse mesocolon: a case report.

We discuss the long history of a patient still alive with a primary gastrointestinal stromal tumour (GIST) of the transverse mesocolon: initially it presented as an acute complication, namely a haemorrhagic shock caused by rupture of the tumour and it recurred twice locally in the years following primary resection. Each time, a macroscopically complete resection could be achieved. Six years after the resection of the primary tumour, a liver metastasis was discovered, which was removed by radio frequency ablation (RFA). Eight months later, the patient developed a new liver metastasis and a retropancreatic mass deemed unresectable. He is treated with imatinib mesylate (Glyvec, Novartis, Vilvoorde, Belgium) since and has had a stable disease for 6 months. Gastrointestinal stromal tumours outside the gastrointestinal tract are rare. Until a few years ago the only possible therapy was surgical resection. Nowadays radio frequency ablation can be a solution for irresectable liver metastases, and imatinib mesylate can bring improvement for advanced and metastasized tumours. Whether this could also be useful as an adjuvant therapy has not yet been investigated, but it could be important knowing that 38% of the tumours recur locally and 15% metastasize. The most important prognostic factors for gastrointestinal stromal tumours are grading and complete resection.

Aged↗
PubMedDate not supplied

Morphology, phylogeny and biology of Gliocephalis hyalina, a biotrophic contact mycoparasite of Fusarium species.

Gliocephalis hyalina, a rarely seen microfungus with a morphology similar to the hyphomycete genus Aspergillus but with slimy conidia was found in a mixed microbial culture from soybean roots. This species has been reported sporadically since 1899, each time in association with other fungi or bacteria. Gliocephalis hyalina has not been maintained in monoxenic culture and requires other fungi to grow. Light and scanning electron microcope studies indicate that it is a biotrophic contact parasite of Fusarium species. The fungus may penetrate the cells but has no apparent deleterious effect on the growth or plant pathogenicity of its host. Phylogenetic analyses of partial nuclear small subunit rDNA sequences place G. hyalina near the Laboulbeniales, an order of obligate insect parasitic microfungi, and the related mycelial genus Pyxidiophora. Gliocephalis hyalina is mycoparasitic along with many Pyxidiophora species. These discoveries suggest that some "unculturable" microorganisms or "cryptic DNA" recovered from environmental DNA samples might represent obligate biotrophs that could be cultured and studied with simple techniques.

Ascomycota↗
PubMedDate not supplied

Flow and the occupational therapy practitioner.

OBJECTIVE: This study examined optimal flow experience, a form of job satisfaction in occupational therapy practitioners employed at physical rehabilitation facilities in New England. METHOD: Factors associated with flow were measured over a 5-day work week with the Experience Sampling Method. Ninety-seven percent of the 90 subjects' responses were analyzed and 43% of the subjects participated in the debriefing interview. RESULTS: Subjects experienced flow a relatively small amount of the time--an average of 5.24 times in a 5-day work week, with a range of 1 to 12 experiences. Flow was experienced most often (23.6%) when subjects were working with a client in some type of intervention. Perceived autonomy and self-esteem were high during a flow experience. Subjects described their flow experiences as including such moods and attitudes as "alert," "happy," "involved," creative," "excited," "productive," "accomplished," "proud," "good," "confident," "positive," and "challenged." Conversely, subjects in flow also tended to describe their mood as "tense." CONCLUSION: Retaining occupational therapy practitioners is critical to meeting and increasing the unprecedented demand for health care services. Understanding what causes occupational therapy practitioners to experience flow and how to transform an activity into a flow experience may ultimately improve job satisfaction, productivity, and the retention of practitioners.

Adult↗
PubMedDate not supplied

The effect of keeping an end-product on intrinsic motivation.

OBJECTIVE: According to literature in occupational therapy and psychology, intrinsic motivation is thought to be enhanced if people can keep the end-product of an activity. The purpose of this study was to examine the effect of keeping an end-product on intrinsic motivation. METHOD: Fifty participants chose one of four activities (painting a ceramic vase, decorating cookies, stringing beads for a necklace, creating stationery) and performed two conditions (keep, no-keep) in counterbalanced order. Participants were timed in each condition and, after each condition, ranked their self-determination and competence, which are psychological needs underlying intrinsic motivation. Participants were interviewed at the end of the study to examine their experiences. RESULTS: Participants worked significantly longer on a chosen activity when the end-product could be kept and rated themselves significantly more self-determined and competent after performing the keep condition. However, further analysis revealed that these results depended on the activity chosen. CONCLUSION: The findings support that keeping an end-product can enhance performance of an activity. However, because results were not consistent across all activity choices, further research is needed to characterize the meaningfulness of particular activities.

Adult↗