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PubMed1978

The simultaneous examination of economic and social factors in destination selection: employing objective and subjective measures.

This research examines the role of social and economic factors in the past selection of destinations made by migrants living in Rhode Island. Results indicate that social ties play a more important role in the selection of destinations with low levels of opportunity than they do in the movement to high opportunity areas. An important aspect of the study was the simultaneous investigation of both objective and subjective measures of social and economic factors in the selection of low and high growth destinations. The analysis suggests that the simultaneous consideration of objective and subjective factors provides a more refined accounting of the potential influence of social and economic factors in the selection of destinations. The findings hold when age is introduced as a control.

Decision Making↗
PubMed1998

General practitioners' referral thresholds and choices of referral destination: an experimental study.

General practitioners (GPs) exert a major impact on NHS resource use, both as providers of primary care and as referrers to secondary care. Referral rates are subject to wide variations, leading to the conjecture that certain GPs may have different 'referral thresholds' from those of others. In this paper, the authors describe an experiment designed both to test the referral threshold hypothesis and to illuminate the GP's decision process with respect to choice over referral destination. Nottinghamshire GPs were provided with hypothetical case histories and a list of possible referral destinations, specifying a range of consultants, their specialist interests, plus the expected waiting times and costs for both out-patient investigation and in-patient treatment. For each case, respondents were requested to indicate whether or not they would refer the patient, and to whom. Respondents were also asked to indicate the extent to which their choices of consultants generally were governed by the specialist interest, the waiting time and the cost information. The responses of the sample support the referral threshold conjecture, with specialist interests and waiting time appearing to be far more important than cost in influencing choice of referral destination. The possibilities of influencing GPs' referral behaviour are discussed, in the light of recent initiatives with respect to prescribing.

Adult↗
PubMed1982

Destination choice of interstate family migrants to selected areas in California.

"In this study an attempt has been made to construct a destination choice model for those families who migrated to California from other states between the years 1965 and 1970. "The empirical work is based on a Public Use Sample of Basic Records from the 1970 Census; the technique of estimation used in this study is McFadden's maximum likelihood (multinomial logit technique which often is referred to as conditional logit). "[The] findings confirm the hypothesis that various groups of migrants respond somewhat differently to the geographic and economic stimuli in selecting their destinations in California. While white family migrants pay attention to the level of expected earnings in selecting their destinations, black family migrants are more concerned with the expansion of economic opportunities (i.e., growth rates of income and employment)."

Black or African American↗
PubMed2006

Ethics guidelines for destination therapy.

The introduction of the left ventricular assist device as a destination therapy for patients with heart failure introduces several ethical issues. These issues are discussed to help destination therapy teams design ethically sound policies and procedures. This article addresses ethical issues pertaining to informed decision making, device failure, and change out, as well as guidelines for deactivation, fair employment of medical and psychosocial criteria, the nature of destination therapy as an elective end-of-life therapy, and advance care planning strategies.

Decision Trees↗
PubMed2006

Hospital costs for left ventricular assist devices for destination therapy: lower costs for implantation in the post-REMATCH era.

BACKGROUND: The use of left ventricular assist devices (LVADs) as an alternative to transplant, or destination therapy (end of life support), is an increasingly important option for patients with end-stage heart failure. Prior studies have examined hospital costs for LVAD implants performed during investigational studies (e.g., REMATCH), but none has been published since that trial was completed. METHODS: We performed a retrospective analysis of 23 consecutive patients who had a HeartMate XVE pump implanted as destination therapy at 2 high-volume ventricular assist device implant centers after US Food and Drug Administration approval in October 2003. We evaluated survival to discharge during the implantation hospitalization, hospital length of stay, and hospital costs, and compared them with outcomes reported from the REMATCH (RM) trial. RESULTS: All patients in this cohort implanted post-REMATCH (PRM) had class IV heart failure and were similar in age, gender, and nearly all other pre-implantation clinical measures to the RM subjects. Mean hospital costs for PRM patients were 40% lower than for RM patients when measured from implantation to discharge (dollar 128,084 vs dollar 210,187, p < 0.01). PRM patients who survived implantation hospitalization had 48% lower costs than those who did not survive (dollar 114,979 vs dollar 215,456, p < 0.01), a finding similar to the RM experience. PRM patients in this cohort were more likely to survive to discharge compared with RM patients (87.0% vs 67.3%, p = 0.09). Mean hospital length of stay was 25% lower in the PRM group (44 vs 33 days) but did not reach statistical significance (p = 0.50). CONCLUSIONS: Outcomes with use of LVADs as destination therapy have improved in the post-REMATCH era, including significantly lower hospital costs as well as strong trends toward better survival to hospital discharge and shorter average length of stay.

Aged↗
PubMed2003

Validation of the Berg Balance Scale as a predictor of length of stay and discharge destination in stroke rehabilitation.

OBJECTIVE: To validate the utility of the Berg Balance Scale (BBS) in predicting length of stay (LOS) and discharge destination for patients admitted to a stroke rehabilitation unit. DESIGN: Prospective study. SETTING: Provincial tertiary inpatient stroke unit for a primarily geriatric population. PARTICIPANTS: A total of 313 of the 325 patients admitted consecutively between April 1998 and August 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: LOS and discharge destination. RESULTS: Admission BBS scores correlated negatively with LOS (r=-.53, controlling for age). Logistic regression confirmed that the following were independent predictors of being discharged home rather than to an institution (adjusted odds ratio, 95% confidence interval): admission BBS (1.09, 1.06-1.12) and the presence of family supports (15.0, 7.2-31.3). These results generally concur with previously published results, obtained at a different stroke rehabilitation setting. CONCLUSIONS: This study validates the use of the BBS scores in assisting to estimate approximate LOS and eventual discharge destination. Age did not correlate significantly with the outcomes measured in this study, which was conducted in a geriatric population.

Activities of Daily Living↗
PubMed1999

The Berg balance scale as a predictor of length of stay and discharge destination in an acute stroke rehabilitation setting.

OBJECTIVE: To examine the utility of the Berg Balance Scale (BBS) in predicting length of stay and discharge destination for patients admitted to a stroke rehabilitation unit. DESIGN: Retrospective study. SETTING: Regional tertiary inpatient stroke rehabilitation unit. PATIENTS: One hundred twenty-eight of 141 patients admitted consecutively between January 1, 1995, and March 31, 1996. MAIN OUTCOME MEASURES: Length of stay and discharge destination. RESULTS: Admission BBS scores and Functional Independence Measure scores correlated with length of stay (r = -0.6 and -0.5, respectively, controlling for age). Logistic regression revealed that the following were independent predictors of being discharged home rather than to an institution (adjusted odds ratio, 95% confidence interval): admission BBS (1.09, 1.04-1.13), age (.89, .83-.95), and presence of family support (11.7, 3.1-44.3). CONCLUSIONS: Measuring the BBS scores of patients upon admission to an acute stroke rehabilitation unit may assist in approximating length of stay and predicting eventual discharge destination.

Acute Disease↗
PubMed1985

Rural-destined migration in Third World settings: a neglected phenomenon?

This paper 1st reviews earlier research on rural-destined migration in Third World settings, in order to derive generalizations for a topic most often treated in idiosyncratic fashion. Descriptive analysis of all Costa Rican migration flows for 1968-73 then establishes that a surprisingly high proportion are rural directed. Finally, statistical analyses identify differences, in terms of explanatory variables, between urban-and rural-destined migrations, and for rural-destined migrations only, between those originating in urban and rural areas.

Americas↗
PubMed2005

The Orpington Prognostic Scale for patients with stroke: reliability and pilot predictive data for discharge destination and therapeutic services.

PURPOSE: To determine the inter-rater and test-retest reliability of the Orpington Prognostic Scale (OPS) in patients with stroke. Pilot data were gathered to evaluate its predictive validity for discharge destination and therapeutic services required on discharge. METHOD: Ninety-four consecutive patients, admitted to hospital due to stroke participated. Pairs of physiotherapists (PT) and occupational therapists (OT) assessed patients using the OPS on days 7 and 14 post stroke. For inter-rater reliability, one rater performed the OPS while the other observed, each scoring the scale independently. For test-retest reliability, two different raters tested the subjects separately within the same day. Data were gathered on the discharge destination and the number of follow-up services prescribed. RESULTS: The inter-rater reliability as measured by the intraclass correlation coefficient (ICC) was 0.99 (95% CI 0.97 - 0.99). For test-retest reliability, the ICC was 0.95 (95% CI 0.90 - 0.98). The accuracy for predicting discharge to home using OPS 5.0 was 65% (95% CI 0.52 - 0.76). OPS scores were not related to number of follow-up services prescribed. CONCLUSIONS: Despite high inter-rater and test-retest reliability, the OPS has limited predictive accuracy for discharge destination and is a poor predictor of follow-up services.

Aged↗
PubMed2005

Overexpression of p27 Kip 1, probability of cell cycle exit, and laminar destination of neocortical neurons.

Neocortical projection neurons arise from a pseudostratified ventricular epithelium (PVE) from embryonic day 11 (E11) to E17 in mice. The sequence of neuron origin is systematically related to mechanisms that specify neuronal class properties including laminar fate destination. Thus, the neurons to be assembled into the deeper layers are the earliest generated, while those to be assembled into superficial layers are the later generated neurons. The sequence of neuron origin also correlates with the probability of cell cycle exit (Q) and the duration of G1-phase of the cell cycle (T(G1)) in the PVE. Both Q and T(G1) increase as neuronogenesis proceeds. We test the hypothesis that mechanisms regulating specification of neuronal laminar destination, Q and T(G1) are coordinately regulated. We find that overexpression of p27(Kip1) in the PVE from E12 to E14 increases Q but not T(G1) and that the increased Q is associated with a commensurate increase in the proportion of exiting cells that is directed to superficial layers. We conclude that mechanisms that govern specification of neocortical neuronal laminar destination are coordinately regulated with mechanisms that regulate Q and are independent of mechanisms regulatory to cell cycle duration. Moreover, they operate prior to postproliferative mechanisms necessary to neocortical laminar assembly.

Algorithms↗
PubMed2002

The destination for single-pass membrane proteins is influenced markedly by the length of the hydrophobic domain.

The tonoplast was proposed as a default destination of membrane-bound proteins without specific targeting signals. To investigate the nature of this targeting, we created type I fusion proteins with green fluorescent protein followed by the transmembrane domain of the human lysosomal protein LAMP1. We varied the length of the transmembrane domain from 23 to either 20 or 17 amino acids by deletion within the hydrophobic domain. The resulting chimeras, called TM23, TM20, and TM17, were expressed either transiently or stably in tobacco. TM23 clearly accumulated in the plasmalemma, as confirmed by immunoelectron microscopy. In contrast, TM17 clearly was retained in the endoplasmic reticulum, and TM20 accumulated in small mobile structures. The nature of the TM20-labeled compartments was investigated by coexpression with a marker localized mainly in the Golgi apparatus, AtERD2, fused to a yellow fluorescent protein. The strict colocalization of both fluorescent proteins indicated that TM20 accumulated in the Golgi apparatus. To further test the default destination of type I membrane proteins, green fluorescent protein was fused to the 19-amino acid transmembrane domain of the plant vacuolar sorting receptor BP-80. The resulting chimera also accumulated in the Golgi instead of in post-Golgi compartments, where native BP-80 localized. Additionally, when the transmembrane domain of BP-80 was lengthened to 22 amino acids, the reporter escaped the Golgi and accumulated in the plasma membrane. Thus, the tonoplast apparently is not a favored default destination for type I membrane proteins in plants. Moreover, the target membrane where the chimera concentrates is not unique and depends at least in part on the length of the membrane-spanning domain.

Amino Acid Sequence↗
PubMed2005

Destination-selective long-distance movement of phloem proteins.

The phloem macromolecular transport system plays a pivotal role in plant growth and development. However, little information is available regarding whether the long-distance trafficking of macromolecules is a controlled process or passive movement. Here, we demonstrate the destination-selective long-distance trafficking of phloem proteins. Direct introduction, into rice (Oryza sativa), of phloem proteins from pumpkin (Cucurbita maxima) was used to screen for the capacity of specific proteins to move long distance in rice sieve tubes. In our system, shoot-ward translocation appeared to be passively carried by bulk flow. By contrast, root-ward movement of the phloem RNA binding proteins 16-kD C. maxima phloem protein 1 (CmPP16-1) and CmPP16-2 was selectively controlled. When CmPP16 proteins were purified, the root-ward movement of CmPP16-1 became inefficient, suggesting the presence of pumpkin phloem factors that are responsible for determining protein destination. Gel-filtration chromatography and immunoprecipitation showed that CmPP16-1 formed a complex with other phloem sap proteins. These interacting proteins positively regulated the root-ward movement of CmPP16-1. The same proteins interacted with CmPP16-2 as well and did not positively regulate its root-ward movement. Our data demonstrate that, in addition to passive bulk flow transport, a destination-selective process is involved in long-distance movement control, and the selective movement is regulated by protein-protein interaction in the phloem sap.

Cucurbita↗
PubMed1987

Destinations of some fast-transported proteins in sensory neurons of bullfrog sciatic nerve.

Many characteristics of proteins that are fast axonally transported have been described, but the destinations of most within the neuron remain unknown. We have studied the destinations of some fast-transported proteins in sensory neurons of the bullfrog sciatic nerve, specifically to determine which may be deposited in axons and which may be destined for more distal, possibly terminal, areas. Dorsal root ganglia were pulse-labeled with [35S]methionine in vitro, following which they were separated from the sciatic nerve. After additional periods of transport, radioactive proteins from two areas of the nerve were separated by two-dimensional polyacrylamide gel electrophoresis and used to develop x-ray film. The first area contained the wavefront of transported radioactivity (wavefront region), whereas the second area was taken from nerve through which the wavefront had already passed (plateau region). The amount of radioactivity in certain fast-transported protein species from each area was determined by computer analysis of digitized video images of fluorographs. Certain proteins were preferentially left behind the wavefront and, therefore, may supply axon and possibly other nerve components, whereas other proteins were found almost exclusively in the wavefront and, hence, may supply more distal, possibly terminal, areas.

Animals↗
PubMed2000

Should pediatric emergency care be decentralized?: an out-of-hospital destination model for critically ill children.

OBJECTIVES: A time-to-initial-stabilization model for out-of-hospital destinations of critically ill children (CICs) was developed. Application of this model to assess the impact of changes in different parameters of an emergency medical services for children (EMSC) system is described. METHODS: A computer model created a 2,500-square-mile community containing ten community hospitals (CHs) and one pediatric critical care center (PCC). Community hospitals capable of providing initial immediate stabilization of CICs were defined as emergency departments accepting pediatrics (EDAPs). Critically ill children were randomly selected in proportion to population densities across the modeled community. Time to initial stabilization (TIS) was defined as the time to arrival at either an EDAP or a PCC or time to arrival at a non-EDAP CH + travel time for a team from the PCC to the non-EDAP CH + preparation/dispatch (P/D) time. The following parameters of the model were varied and their effect on TIS was evaluated: location of CHs, location of PCC, primary destinations for CICs, percent of CHs meeting EDAP standards, out-of-hospital compliance with designated hospitals for CICs, P/D time, and ambulance speed. RESULTS: The computer model selected 1,000 CICs in accordance with the population densities of the community. The scenario with the shortest TIS was one in which every CH achieved EDAP designation (9.8 +/- 0.5 minutes). The scenario with the longest TIS involved a model in which every CIC was transported directly to the PCC (28.6 +/- 0.33 minutes). The number of EDAPs in a community and out-of-hospital compliance with use of EDAPs produced comparable effects on the TIS. Travel speeds had a direct effect on TIS but also exaggerated inefficiencies between scenarios. The P/D time had little effect on the TIS. CONCLUSIONS: An out-of-hospital destination model has been developed with the ability to modify multiple EMSC system variables. Application of this model demonstrates the shortest times to stabilization of critically ill children occur in systems that maximize the number of hospitals that meet EDAP standards and decentralize pediatric emergency care.

Adolescent↗
PubMed2005

Race, gender, and marriage: destination selection during the Great Migration.

Using historical census microdata, we present a unique analysis of racial and gender disparities in destination selection and an exploration of hypotheses regarding tied migration in the historical context of the Great Migration. Black migrants were more likely to move to metropolitan areas and central cities throughout the period, while white migrants were more likely to locate in nonmetropolitan and farm destinations. Gender differences were largely dependent on marital status. Consistent with the "tied-migration" thesis, married women had destination outcomes that were similar to those of men, whereas single women had a greater propensity to reside in metropolitan locations where economic opportunities for women were more plentiful.

Black or African American↗
PubMed1998

Two women with multiple disabilities sharing an acoustic orientation system and traveling together to indoor destinations.

This study assessed whether two women with total blindness and profound intellectual disability could share an acoustic orientation system and travel together simultaneously to common indoor destinations to perform occupational and vocational activities. The orientation system provided acoustic cues which indicated the direction to the destinations. Analysis of data indicated that the women were successful in sharing the system and could reach the destinations independently.

Acoustic Stimulation↗
PubMedDate not supplied

The relationship between convenience of destinations and walking levels in older women.

PURPOSE: To examine the relationship between physical activity and (1) convenience of destinations, measured by whether destinations (such as a park, trail, businesses, and services) are within walking distance of the home, and (2) participants' perception of the quality of their neighborhood surroundings for walking, captured with a global neighborhood "walkability" rating. DESIGN: Cross-sectional analysis of data obtained in 1999. SETTING: Community in southwest Pennsylvania. SUBJECTS: Older Caucasian women (n = 149, mean age = 74.2 years). Response rate = 79%. MEASURES: Walking levels, leisure-time physical activity, and features of the neighborhood environment were measured with interviewer-administered questionnaires. Physical activity was also measured objectively with a pedometer. RESULTS: Living within walking distance (defined as within a 20-minute walk of home) of a park; biking or walking trail; or department, discount, or hardware store was related to higher pedometer readings (p < .01). In addition, there was a positive trend between the sum of destinations within walking distance of home and activity levels measured by pedometer and questionnaire (p < .01). There was also a positive trend between participants' neighborhood "walkability" rating and activity levels measured by pedometer and questionnaire (p < .01). CONCLUSION: These findings suggest that the ability to make utilitarian walking trips from home and the perception of having favorable neighborhood surroundings for walking are associated with increased physical activity levels in older women.

Aged↗
PubMedDate not supplied

Triage, transportation, and destination decisions by out-of-hospital emergency care providers.

INTRODUCTION: The effectiveness of a tiered emergency medical services system often hinges upon the ability of initial care providers with little or no formal training to identify emergent patient needs and determine the best means to meet those needs. OBJECTIVES: To determine if out-of-hospital emergency care providers consistently make appropriate triage, transportation, and destination decisions; and to determine if experience and training have an effect on these decisions. METHODS: A survey consisting of 14 patient-care scenarios was administered to certified and non-certified out-of-hospital emergency-care providers (n = 311) from 20 randomly selected EMS agencies. These agencies were part of EMS systems that utilize one, two, and three tiered responses by ambulance and fire-based commercial, municipal, and volunteer agencies. Participants were asked to select the most appropriate mode of transport and destination facility using the assumption that they had responded to each scenario in a basic life support ambulance. Answers included transporting the patient to various receiving facilities or requesting a more advanced-level unit to respond to the scene. Transport times to receiving facilities and estimated times of arrival for advanced-level units were provided with each choice. Eight emergency physicians unanimously had agreed upon the most appropriate answer for each scenario. A two-tailed t-test was used to compare the scores of the certified and non-certified groups; and Spearman's Correlation Coefficients were used to test the effects of experience and training. RESULTS: Non-certified providers (n = 108) had a mean score of 32.6% or 4.6 (SD = 1.84) correct answers; certified providers (n = 203) had a mean score of 41.1% or 5.76 (SD = 2.12) correct answers (p < 0.000001). Spearman's Correlation Coefficients were: 1) individual provider level--(0.3978); 2) agency provider level--(0.2741); 3) hours worked per week--(0.2505); 4) years in EMS--(-0.0821); 5) commercial or volunteer provider--(0.2398); 6) agency call volume--(0.2012); 7) agency location--(0.0685), and 8) transporting versus non-transporting agency--(0.2523). CONCLUSIONS: A need exists for further education of out-of-hospital emergency care providers with respect to triage, transportation, and destination decisions. Provider experience and level of certification do not appear to affect these critical patient-care decisions.

Caregivers↗