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At least 271 records · Page 15Linked to original sources
PubMed2000

Olfactory foraging by Antarctic procellariiform seabirds: life at high Reynolds numbers.

Antarctic procellariiform seabirds forage over vast stretches of open ocean in search of patchily distributed prey resources. These seabirds are unique in that most species have anatomically well-developed olfactory systems and are thought to have an excellent sense of smell. Results from controlled experiments performed at sea near South Georgia Island in the South Atlantic indicate that different species of procellariiforms are sensitive to a variety of scented compounds associated with their primary prey. These include krill-related odors (pyrazines and trimethylamine) as well as odors more closely associated with phytoplankton (dimethyl sulfide, DMS). Data collected in the context of global climatic regulation suggest that at least one of these odors (DMS) tends to be associated with predictable bathymetry, including upwelling zones and seamounts. Such odor features are not ephemeral but can be present for days or weeks. I suggest that procellariiforms foraging over vast distances may be able to recognize these features reflected in the olfactory landscape over the ocean. On the large scale, such features may aid seabirds in navigation or in locating profitable foraging grounds. Once in a profitable foraging area, procellariiforms may use olfactory cues on a small scale to assist them in locating prey patches.

Animals↗
PubMed1992

Shangri-La revisited: an exploration of therapeutic efficacy among intentional communities.

Field and literature surveys were employed to explore the therapeutic efficacy of a reportedly common set of social structures found among some Intentional Communities (ICs). Substance misuse served as an example of social problems plausibly related to the examined social structures, which included: (1) meditative practices, (2) progressive education, (3) holistic health practices, (4) nutritional diet, (5) open policy making, (6) equally or equitably shared resources, (7) integrating membership processes, and (8) environmental concern. The field survey identified and examined 11 such ICs, and the literature exploration concerning the structures found that they appear to be therapeutic. Future research should focus on refining the study of structural and antecedent variables and on finding relationships between these variables to communities in the larger society.

Female↗
PubMed1998

Model of computerized academic medical clinic.

In the traditional medical graduation course, the student receives a great amount of information while training at the Outpatient Care; the student assumes the physician's role, collecting all the information regarding the patient's clinical history and learns to get along with patients as well. During the attendance process, several factors interfere in the academic teaching, such as limitations of room numbers, amount of patients, difficulties in obtaining medical records, paper illegibility, among other problems. Due to those difficulties, the Model of Computerized Academic Health Clinic, implies in a new learning paradigm in the medical practice, rethinking the traditional process of learning-attendance, where the old model, in which attendance is restricted to a place, is extended in an open atmosphere of shared knowledge, rich of computer resources. The pilot project was implanted in the Pediatrics General Health Clinic of UNIFESP/EPM. It allows that the fifth-year medical students, residents, trainees and tutors use computerized clinics, connected with the academic net of UNIFESP and to the Internet. All the computing and information resources settled at the Outpatient Care improved the organization of its services, increased the medical students' curiosity, improved their participation in learning through interactive programs and clinical attendance.

Academic Medical Centers↗
PubMed2001

Open versus percutaneous dilatational tracheostomy: efficacy and cost analysis.

The economic advantages of percutaneous dilatational tracheostomies versus open tracheostomies in the operating room have been thoroughly evaluated. We are now reporting our comparison of the costs and charges of percutaneous dilatational tracheostomies with those of open bedside tracheostomies at our institution. The current literature comparing the two open techniques and the percutaneous method of placing tracheostomies was reviewed and the charges and costs for these procedures at our institution were compared. Patients were placed into one of three groups for analysis: open tracheostomies in the operating room (Group I), open tracheostomies in the intensive care unit (Group II), and percutaneous dilatational tracheostomies in the intensive care unit (Group III). Based on our own experience and a literature review it is evident that all three approaches to tracheostomies are safe. Economic analysis showed a savings of $180 in cost per procedure and a $658 savings in charges per procedure for the open method at the bedside when compared with the percutaneous method at the bedside. The professional fee for bronchoscopy was not included in this calculation; including this would lead to greater savings with the open method over the percutaneous method. Open tracheostomy in the operating room increased costs over the bedside procedure by $2194 and increased charges by $2871. For the 150 to 180 tracheostomies done each year at our institution utilization of the open technique at the bedside results in a cost savings of approximately $31,500 and a charge savings of $109,000 compared with the percutaneous dilatational tracheostomy. Both the open bedside and percutaneous dilatational methods are reasonable and safe options. However, the open bedside tracheostomy is a better utilization of resources and is more cost effective, and it is the procedure of choice at our institution.

Cost Savings↗
PubMed2001

Introduction of computational models to PhysioNet.

PhysioNet is a national research resource that provides experimental data sets and open-source software for their analysis. Computational modeling can complement studies of these experimental data sets so as to facilitate the advancement of physiologic research. Thus, in order to introduce computational models to PhysioNet, we have developed and posted a cardiovascular model designed for research that generates reasonable human pulsatile hemodynamic waveforms, cardiac output and venous return curves, and beat-to-beat variability. Some of the key features of the software include: 1) compatibility with PhysioNet's open-source data analysis software; 2) online viewing and parameter updating as the data are being calculated; 3) off-line viewing after completion of the simulation; 4) pre-compiled Linux binaries; 5) open-source code that may be compiled on other platforms; and 6) an extensive user's manual and software guide.

Cardiac Output↗
PubMed2004

[The survey of Lithuanian physicians and medical residents regarding possible migration to the European Union].

The aim of this survey was to evaluate intentions of Lithuanian physicians and medical residents to work in the European Union (EU) and other countries. The survey was performed in 2002 in the framework of the project "Health human resource development and planning in Lithuania", sponsored by Open Society Fund, Lithuania. Using the questionnaire developed by the Ministry of Labor and Solidarity of France, 242 medical residents and 497 physicians were surveyed. Survey results indicated that 60.7% of medical residents and 26.0% of physicians intended to leave for the EU or other countries. The survey also showed that the first-choice countries were United Kingdom, Germany and the Nordic countries. Almost 15.0% of medical residents and 5.0% of physicians planed to leave for the EU on permanent basis. The largest part of those who intended to leave for the EU, planned to go there after accession. It was a definitive decision of 2.5% of medical residents and 3.8% of physicians. The major reasons for leaving were higher salary, better professional possibilities and better quality of life. For medical residents a previous visit abroad for professional reasons increased the risk of working abroad significantly (OR-3.29, 95% CI 1.73-6.27). In the case of physicians, age was the factor that significantly decreased the risk (OR-0.94, 95% CI 0.91-0.96); however having friends abroad increased the risk by more than three times (OR-3.22, 95% CI 1.91-5.42). In order to observe the possible migration to the EU or other countries, the survey should be repeated every three-four years.

Adult↗
PubMed2006

Tools for priority setting: lessons from South Australia.

BACKGROUND: This paper provides an overview of the process and tools used to develop and implement a priority setting framework for the Clinical Senate of South Australia. Established as a clinical advisory group to the Minister and Department of Health, the Clinical Senate recognised the need for an open priority setting process to fairly assign planning resources to the large number of clinical issues that needed to be addressed. DISCUSSION: Using a workbook, developed from the literature and evidence related to priority setting, agreement was reached on the use, components and structure of the priority setting process. The final products included a Gap Finder Tool and a Priority Setting Framework. SUMMARY: This paper describes the process used to develop the priority setting tools. Decision makers in other organisations can use similar processes and tools to develop or enhance their priority Setting processes.

Health Priorities↗
PubMed1982

Leadership in care of the elderly: assessing needs and challenges.

What opportunities and challenges for nursing leadership present themselves in institutions that provide care for our expanding aged population? Should nursing administrators take up these challenges? If so, what skills, resources, and attitudes will they need? This article opens the door for further exploration of these questions. The discussion stimulates thinking about the levels of involvement, authority, and responsibility that nursing administrators can and should have in providing care for the elderly. The article further suggests opportunities and benefits that such leadership can provide for patients, nurses, and society.

Administrative Personnel↗
PubMed2003

The Guidant Ancure bifurcation endograft: five-year follow-up.

The aim of this study was to provide a 5-year update on the Guidant/Ancure bifurcated endograft clinical trial. The Guidant trial was a prospective, nonrandomized comparative control designed to evaluate the immediate and long-term results of a bifurcated endograft repair of abdominal aortic aneurysm compared with an open control group. The experimental group consisted of 573 patients, all of whom were followed up for one year, a cadre of 319 patients who were followed up for 5 years, and the control group that consisted of 111 patients who were also followed up for 5 years. A total of 92.7% of the endograft patients underwent successful implantation. Thirty-day mortality rate for the endovascular group was 1.7% compared with 2.7% for the open repair group (P value, not significant). Endovascular repair showed statistically significant improvement in items of resource utilization including reduced blood loss, reduced utilization of intensive care unit (ICU), and shortened hospital stay. There was also a statistically significant reduction in major morbid events (28.8% aggregate) when compared with open surgical control (41.1% aggregate). At the end of the 5-year interval, there was no statistically significant difference in survival rate between the 2 groups, and no patient in the endograft group suffered from aneurysm sac rupture. Endovascular repair of an abdominal aortic aneurysm using a Guidant bifurcated graft resulted in a statistically significant reduction of perioperative morbidity, was conserving of hospital resources, has a comparable long-term survival with open surgical repair, and protected patients from aneurysm rupture when followed up to 5 years.

Aortic Aneurysm, Abdominal↗
PubMed2004

Diel feeding periodicity of larval anopheline mosquitoes on microorganisms and microinvertebrates: a spatial and temporal comparison of Anopheles quadrimaculatus (Diptera: Culicidae) diets in a Michigan pond.

Diel feeding activity of third and fourth instars of Anopheles quadrimaculatus Say were studied in a Michigan permanent pond. This field study examined the consumption of microbial and microinvertebrate food resources over a diel (24-h) period between two habitats (open water and vegetated areas). A fluorochromatic stain (4,6-diamidino-2-phenylindole) was used to quantify microbial dietary components within larval guts and habitats. Microbial analyses show that bacteria were the most abundant food type, followed by detritus, algae, and invertebrate parts/protozoans (IPP). Larval consumption of cladocerans was significantly greater at midnight than noon. Larval gut analyses examined every hour over a 24-h period provided significant evidence as to the approximate time larvae switch microinvertebrate dietary resources. Habitat had a significant effect on microinvertebrate consumption by An. quadrimaculatus larvae. Larvae consumed more water mites and rotifers in the open water areas than vegetated zones. We found that An. quadrimaculatus larvae do not preferentially feed on microinvertebrates over a diel period, however, larvae may feed selectively on rotifers in open water habitats. Knowledge of the "feeding area" or microhabitats, with respect to where and when larvae optimally forage as well as particle sizes and food types consumed in the natural habitats will enhance the success of bacteria and other particulate larvicides.

Animals↗
PubMed2006

Treatment of abdominal compartment syndrome with subcutaneous anterior abdominal fasciotomy in severe acute pancreatitis.

BACKGROUND: Managing the abdominal compartment syndrome associated with severe acute pancreatitis by the open abdomen method is associated with considerable morbidity and resource utilization. METHODS: A technique of subcutaneous anterior abdominal fasciotomy is described for the first time in two patients with severe acute pancreatitis. RESULTS: Following the procedure, the intra-abdominal pressure decreased from 30 mmHg immediately to 23 mmHg and to a sustained level of 12-14 mmHg in the first patient, and from 35 mmHg immediately to 23 mmHg and to a sustained level of 14-19 mmHg in the second patient. CONCLUSIONS: The subcutaneous anterior abdominal fasciotomy is a promising method for safe and effective abdominal decompression with sustained effect and avoiding the morbidity associated with the alternative open abdomen techniques.

Abdominal Wall↗
PubMed2002

The World Bank's innovation market.

Large, tradition-bound organizations can make space for radical, low-cost (and therefore low-risk) innovations. Just ask executives at the World Bank. The story of this best practice begins in 1998, when a young new-products group at the international funding agency proposed holding an Innovation Marketplace to capture novel ideas within the Bank for alleviating poverty. The forum, which eventually was opened to external participants, let people informally present their antipoverty ideas to potential funding sources. Funders could move among hundreds of booths and evaluate proposals for, say, a program that would provide postdisaster reconstruction insurance in developing countries or a vaccination development initiative. The marketplace truncated the Bank's standard project-review processes, which often stretched to a year or more, and gave funders permission to make commitments in the tens of thousands of dollars, rather than in the tens of millions more typical of Bank-financed projects. The marketplace concept met with some skepticism at the beginning. Some senior executives at the Bank felt no group had the right to spend the agency's money without following its well-established resource allocations process. But the marketplace team believed an open process for allocating grants would produce more breakthrough ideas in the long run than a centralized one. In this article, the authors describe how the new-products team brainstormed to create a market for ideas, how it got senior management's support, and how it has expanded on the original concept for these innovation marketplaces. The program's success, they contend, offers hope both for the world's poor and for business leaders looking to find new ideas under the hard crust of corporate dogma, conformance, and bureaucracy.

Cooperative Behavior↗
PubMed2006

Protein Circular Dichroism Data Bank (PCDDB): data bank and website design.

The Protein Circular Dichroism Data Bank (PCDDB) is a new deposition data bank for validated circular dichroism spectra of biomacromolecules. Its aim is to be a resource for the structural biology and bioinformatics communities, providing open access and archiving facilities for circular dichroism and synchrotron radiation circular dichroism spectra. It is named in parallel with the Protein Data Bank (PDB), a long-existing valuable reference data bank for protein crystal and NMR structures. In this article, we discuss the design of the data bank structure and the deposition website located at http://pcddb.cryst.bbk.ac.uk. Our aim is to produce a flexible and comprehensive archive, which enables user-friendly spectral deposition and searching. In the case of a protein whose crystal structure and sequence are known, the PCDDB entry will be linked to the appropriate PDB and sequence data bank files, respectively. It is anticipated that the PCDDB will provide a readily accessible biophysical catalogue of information on folded proteins that may be of value in structural genomics programs, for quality control and archiving in industrial and academic labs, as a resource for programs developing spectroscopic structural analysis methods, and in bioinformatics studies.

Circular Dichroism↗
PubMed1997

Cost-effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphy. Coala trial group.

OBJECTIVE: To determine the cost-effectiveness of laparoscopic inguinal hernia repair. SUMMARY BACKGROUND DATA: Laparoscopic inguinal hernia repair seems superior to open techniques with respect to short-term results. An issue yet to be studied in depth remains the cost-effectiveness of the procedure. As part of a multicenter randomized study in which >1000 patients were included, a cost-effectiveness analysis from a societal point of view was performed. METHODS: After informed consent, all resource costs, both in and outside the hospital, for patients between August 1994 and July 1995 were recorded prospectively. Actual costs were calculated in a standardized fashion according to international guidelines. The main measures used for the evaluation of inguinal hernia repair were the number of averted recurrences and quality of life measured with the Short Form 36 questionnaire. RESULTS: Resource costs were recorded for 273 patients, 139 in the open and 134 in the laparoscopic group. Both groups were comparable at baseline. Average total hospital costs were Dfl 1384.91 (standard deviation: Dfl 440.15) for the open repair group and Dfl 2417.24 (standard deviation: Dfl 577.10) for laparoscopic repair, including a disposable kit of Dfl 676. Societal costs, including costs for days of sick leave, were lower for the laparoscopic repair and offset the hospital costs by Dfl 780.83 (75.6%), leaving the laparoscopic repair Dfl 251.50 more expensive (Dfl 4665 versus Dfl 4916.50). At present, the recurrence rate is 2.6% lower after laparoscopic repair. Thus, 38 laparoscopic repairs, costing an additional Dfl 9,557, prevent the occurrence of one recurrent hernia. Quality of life was better after laparoscopic repair. CONCLUSION: A better quality of life in the recovery period and the possibility of replacing parts of the disposable kit with reusable instruments may result in the laparoscopic repair becoming dominantly better--that is, less expensive and more effective from a societal perspective.

Cost-Benefit Analysis↗
PubMed2004

Strategies to address increased demand for colonoscopy: Guidelines in an open endoscopy practice.

BACKGROUND AND AIMS: Since Medicare approval for reimbursement of screening colonoscopies, the number of colonoscopy requests has increased. Physician resources have often been inadequate to meet the demand. We sought to reduce the demand for colonoscopy in an open endoscopy system by using a guideline-based triage system to eliminate inappropriate procedures and to align the timing of surveillance colonoscopies with recommendations made by national organizations. METHODS: This was a cohort study with primary care outpatients. From October 2002 to February 2003, 498 consecutive patients on a waiting list of 2400 awaiting colonoscopy for all indications were triaged and are the focus of the study. Selection of patients for appropriate colonoscopy was based on consensus guidelines developed for institutional use by using established published guidelines for appropriate colonoscopy indications. RESULTS: Of the 498 consecutive patients triaged, 139 (28%) were deemed inappropriate. The most common reason was inappropriate referral for surveillance of colorectal polyps. The percentage of inappropriate referrals by the 3 largest referring specialties (internal medicine, family medicine, and gastroenterology) combined was also 28% with no statistically significant differences between specialties. CONCLUSIONS: Most referrals for colonoscopy in an open-access endoscopy system were appropriate, although about 1 in 4 were not. Use of triage and further education of physicians regarding colonoscopy may optimize colonoscopy utilization.

Cohort Studies↗
PubMed2004

An endomechanical product evaluation and selection program by a healthcare resource management group purchasing organization.

The purpose of this report is to describe an endomechanical product evaluation and selection program in open surgical procedures as well as laparoscopic surgery designed by hospital representatives of Consorta, Inc. (Rolling Meadows, Illinois), a leading healthcare resource management and group purchasing organization, and Auto Suture/United States Surgical, (a division of Tyco Healthcare Group LP, Norwalk, Connecticut). In this evaluation program, twenty-three facilities of the six Consorta shareholder partners hospitals enrolled surgeons to participate in this nonexperimental observational study of the clinical performance of endomechanical products. Performance characteristics of the endomechanical products produced by Auto Suture that were evaluated in 1145 surgical procedures included clinically acceptable ratings, clinically not acceptable ratings, as well as superior ratings in 2988 product evaluations. In this endomechanical product evaluation, the surgeons found that the endomechanical products were clinically acceptable in 97.7% of the evaluations. In these endomechanical products that were judged to be clinically acceptable, the surgeons gave a superior rating to 20% of the products. It is important to emphasize that the clinically acceptable performance of laparoscopic products (98.1%) was very similar to that of endomechanical performance during open surgery (96.9%). Similarly, a superior rating of laparoscopic products that were judged to be clinically acceptable (22%) was comparable to that of the superior rating for endomechanical products that were considered to be clinically acceptable during open surgery (16%). The general surgeons who performed the majority (64.3%) of the product evaluations for the endomechanical products found an extremely high clinical acceptable rating in 98.2% of the evaluations. The obstetricians and gynecologists who performed the next highest number of procedures, 427 (14.3%), had a clinically acceptable rating of 97.0%. The lowest clinically acceptable rating (86.3%) for endomechanical products was reported by orthopedic surgeons who performed only 2.7% of the evaluations.

Consumer Product Safety↗
PubMed2005

Does trade affect child health?

Frankel and Romer [Frankel, J., Romer, D., 1999. Does trade cause growth? American Economic Review 89 (3), 379-399] documented positive effects of geographically determined trade openness on economic growth. At the same time, critics fear that openness can lead to a "race to the bottom" that increases pollution and reduces government resources for investments in health and education. We use Frankel and Romer's gravity model of trade to examine how openness to trade affects children. Overall, we find little harm from trade, and potential benefits largely through slightly faster GDP growth.

Child Welfare↗
PubMed2003

Prospective evaluation of a screen for complex discharge planning in hospitalized adults.

OBJECTIVES: To test the predictive ability of the Probability of Repeated Admission (PRA) screen for nonroutine discharge planning (requiring new referrals for formal services). DESIGN: Prospective cohort. SETTING: Two hospitals within a large Midwestern, tertiary care, referral-based system. PARTICIPANTS: Nine hundred ninety-one hospitalized adults identified using a systematic sampling strategy. MEASUREMENTS: The PRA screen was administered, and use of nonroutine discharge planning resources and nonroutine discharge disposition were determined using observation and open record review. Prolonged length of stay was determined by comparing the actual length of stay with the combined average length of stay for diagnosis-related groupings. RESULTS: Significant differences in PRA scores existed in two of three endpoints, but the differences were small, and the ranges of scores overlapped almost completely. Using, logistic regression, items predicting use of nonroutine discharge-planning resources were self-rated health, caregiver availability, age, and sex (chi-square (chi2) = 105.7, df = 9, P <.001), accounting for 17.9% of the variability and area under receiver operating characteristic curve (AUC) of 0.74. Self-rated health and sex predicted prolonged length of stay (chi2 = 15.3, df = 5, P =.009), but only explained 2.2% of the variability, with an AUC of 0.58. The predictors of nonroutine discharge disposition were self-rated health, caregiver availability, age, sex, and diabetes mellitus (chi2 = 125.8, df = 11, P <.001), accounting for 23.0% of the variability, with an AUC of 0.79. CONCLUSION: The clinical utility of using the PRA as a screen for early identification of persons who use nonroutine discharge planning is limited, although certain individual items may be useful.

Aged↗