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PubMed1994

Implementing a nursing administration local area network.

Several factors should be considered in planning and implementing a nursing administration Local Area Network (LAN). Initial support from nursing management and your organization's information systems department are key to successful acceptance by hospital administration. Involvement of all users and support staff in the process will assure acceptance and an efficient roll-out. Flexibility is critical as the best-laid plans suffer delays when a large project is initiated. Adequate support will assure a smoother process for implementing and maintaining a nursing LAN.

Costs and Cost Analysis↗
PubMed2005

A signal processing pipeline for noninvasive imaging of ventricular preexcitation.

OBJECTIVES: Noninvasive imaging of the cardiac activation sequence in humans could guide interventional curative treatment of cardiac arrhythmias by catheter ablation. Highly automated signal processing tools are desirable for clinical acceptance. The developed signal processing pipeline reduces user interactions to a minimum, which eases the operation by the staff in the catheter laboratory and increases the reproducibility of the results. METHODS: A previously described R-peak detector was modified for automatic detection of all possible targets (beats) using the information of all leads in the ECG map. A direct method was applied for signal classification. The algorithm was tuned for distinguishing beats with an adenosine induced AV-nodal block from baseline morphology in Wolff-Parkinson-White (WPW) patients. Furthermore, an automatic identification of the QRS-interval borders was implemented. RESULTS: The software was tested with data from eight patients having overt ventricular preexcitation. The R-peak detector captured all QRS-complexes with no false positive detection. The automatic classification was verified by demonstrating adenosine-induced prolongation of ventricular activation with statistical significance (p <0.001) in all patients. This also demonstrates the performance of the automatic detection of QRS-interval borders. Furthermore, all ectopic or paced beats were automatically separated from sinus rhythm. Computed activation maps are shown for one patient localizing the accessory pathway with an accuracy of 1 cm. CONCLUSIONS: The implemented signal processing pipeline is a powerful tool for selecting target beats for noninvasive activation imaging in WPW patients. It robustly identifies and classifies beats. The small beat to beat variations in the automatic QRS-interval detection indicate accurate identification of the time window of interest.

Action Potentials↗
PubMed2006

What is submitted and what gets accepted in Indian Pediatrics: analysis of submissions, review process, decision making, and criteria for rejection.

OBJECTIVES: To identify the characteristics of the manuscripts submitted to the Indian Pediatrics; attributes of the peer-review process and decision-making; and factors associated with their acceptance or rejection. METHODS: All submissions to Indian Pediatrics during 2002 were analyzed by a retrospective review of records. Manuscripts were categorized by their place of origin (Indian vs. foreign), geographic region of India (north, south, east, west, central), submitting institution (teaching vs. non-teaching), subject (general pediatrics, systemic pediatrics, neonatology, genetic syndrome, allied sub-specialities, etc.), and type of article (research paper, case report, images, letter to editor, review, etc.). Manuscript details were recorded in a database that also included information on peer reviewer assignment, editorial and reviewer comments, and final disposition of the manuscript. Characteristics of accepted and rejected manuscripts were compared. RESULTS: Indian Pediatrics received 687 manuscripts for consideration in the year 2002; mostly from Indian authors (89%). Maximum contributions were received from North India (236, 39%) followed by 165 (27%) from South, 95 (16%) from West, 90 (15%) from Central and 26 (4%) from Eastern part of India. Of 687 papers, 457 (66%) articles qualified for peer review. Agreement between the reviewers was not significantly greater than that expected by chance; kappa for inter-rater agreement was 0.35, 0.17 and 0.21 between any two sets of reviewers for 431, 228 and 203 articles, respectively (P < 0.005). Of 687 submitted manuscripts, 294(43%) were accepted, 347(50%) were rejected and no decision was possible on 46(7%) manuscripts. The top reasons for rejection were 'absence of a message', 'lack of originality', 'inadequate methods', 'not relevant to journal', 'over-interpretation of results', 'unsatisfactory writing style', 'inaccurate/inconsistent/insufficient data', and 'inappropriate statistical analysis', in that order. Median number of days (IQR) needed to reach the final decision was 81 (25-210) d; ranging from 8 (3-29.5) d for Images to 180 (90-341) d for Research papers. No preference for acceptance was noted for foreign articles, geographic region of India, type of institution, or a particular topic, on both univariate and multivariate analysis. CONCLUSION: Indian Pediatrics is receiving contributions from all over India. Majority of the manuscripts are peer-reviewed. Of every 10 articles submitted, almost 4 are accepted. Median time interval from submission to final decision is less than 3 months. The decision-making is not influenced by the place of origin of manuscript.

Bibliometrics↗
PubMed2007

Defining acceptable levels for ecological indicators: an approach for considering social values.

Ecological indicators can facilitate an adaptive management approach, but only if acceptable levels for those indicators have been defined so that the data collected can be interpreted. Because acceptable levels are an expression of the desired state of the ecosystem, the process of establishing acceptable levels should incorporate not just ecological understanding but also societal values. The goal of this research was to explore an approach for defining acceptable levels of ecological indicators that explicitly considers social perspectives and values. We used a set of eight indicators that were related to issues of concern in the Lake Champlain Basin. Our approach was based on normative theory. Using a stakeholder survey, we measured respondent normative evaluations of varying levels of our indicators. Aggregated social norm curves were used to determine the level at which indicator values shifted from acceptable to unacceptable conditions. For seven of the eight indicators, clear preferences were interpretable from these norm curves. For example, closures of public beaches because of bacterial contamination and days of intense algae bloom went from acceptable to unacceptable at 7-10 days in a summer season. Survey respondents also indicated that the number of fish caught from Lake Champlain that could be safely consumed each month was unacceptably low and the number of streams draining into the lake that were impaired by storm water was unacceptably high. If indicators that translate ecological conditions into social consequences are carefully selected, we believe the normative approach has considerable merit for defining acceptable levels of valued ecological system components.

Data Collection↗
PubMed1986

Nitrates in ground and drinking water: analysis of policies and regulations.

On the societal level, risks are the result of collective processes of definition. Accepted risks are mainly the output and secondarily the (scientific) input of these processes. As a consequence, in this paper the question of risk management of the nitrate burden to ground and drinking water is analysed within the framework of comparative policy analysis. Various actors pursue their respective interests in different policy arenas within the given rules of the policy game. The impacts of the policy outputs on the policy addressees, namely farmers and water companies, (substantially) determine the level of actual risk. Different national regulatory styles and traditions towards nitrate regulation shape the policy outputs. Consequently, the assumption or normative postulate of a 'rational' (scientific) risk assessment and risk management appears to be utterly heroic and, in the end, misleading.

Germany, West↗
PubMed1998

Dopamine and the mechanisms of cognition: Part I. A neural network model predicting dopamine effects on selective attention.

BACKGROUND: Dopamine affects neural information processing, cognition, and behavior; however, the mechanisms through which these three levels of function are affected have remained unspecified. We present a parallel-distributed processing model of dopamine effects on neural ensembles that accounts for effects on human performance in a selective attention task. METHODS: Task performance is stimulated using principles and mechanisms that capture salient aspects of information processing in neural ensembles. Dopamine effects are simulated as a change in gain of neural assemblies in the area of release. RESULTS: The model leads to different predictions as a function of the hypothesized location of dopamine effects. Motor system effects are simulated as a change in gain over the response layer of the model. This induces speeding of reaction times but an impairment of accuracy. Cognitive attentional effects are simulated as a change in gain over the attention layer. This induces a speeding of reaction times and an improvement of accuracy, especially at very fast reaction times and when processing of the stimulus requires selective attention. CONCLUSIONS: A computer simulation using widely accepted principles of processing in neural ensembles can account for reaction time distributions and time-accuracy curves in a selective attention task. The simulation can be used to generate predictions about the effects of dopamine agonists on performance. An empirical study evaluating these predictions is described in a companion paper.

Attention↗
PubMed1997

Surgical process scheduling: a structured review.

There is no generally accepted definition of surgical process scheduling available in the literature; nursing researchers, physicians, administrators, and management scientists each view scheduling differently. To overcome this communication problem, a number of authors have proposed conceptual frameworks for surgical process scheduling. These frameworks have unfortunately been either unsatisfactory or incomplete. In this paper, we describe a conceptual framework for surgical process scheduling and use it to classify the existing literature. Results from the review indicate that while operational aspects of advance and allocation scheduling are well understood, further research should be directed towards resolving scheduling issues at strategic and administrative levels. In addition, techniques for integrating operating room (OR) scheduling with other hospital operations are required.

Appointments and Schedules↗
PubMed2003

Commercial scale pulsed electric field processing of tomato juice.

Effects of commercial scale pulsed electric field (PEF) processing on the quality of tomato juice were studied and compared with those of thermal processing. Tomato juice was prepared by hot break at 88 degrees C for 2 min or by cold break at 68 degrees C for 2 min and then thermally processed at 92 degrees C for 90 s or PEF processed at 40 kV/cm for 57 micros. Thermally processed, PEF processed, and unprocessed control juices were packed into 50 mL sterilized polypropylene tubes in a sanitary glovebox and stored at 4 degrees C for 112 days. Both thermally and PEF processed juices showed microbial shelf life at 4 degrees C for 112 days. The lipoxygenase activities of thermally and PEF processed juices were 0 and 47%, respectively. PEF processed juice retained more ascorbic acid than thermally processed juice at 4 degrees C for 42 days (p < 0.05). No significant differences were observed in the concentration of lycopene, degrees Brix, pH, or viscosity between thermally and PEF processed juices during the storage (p > 0.05). Sensory evaluations indicated that flavor and overall acceptability of PEF processed juice were preferred to those of thermally processed juice (p < 0.05).

Ascorbic Acid↗
PubMed1997

[Preferential habits of consumers of common bean (Phaseolus vulgaris L.) in Mexico].

A detailed knowledge of the consumer's preferences for the different classes of common bean is useful to define objectives in bean breeding and quality projects in a given region or country and it is also a valuable tool to design marketing strategies. The present work consisted on the application of a survey to 1514 common bean consumers in 14 states of Mexico. To facilitate the interpretation of the results the country was divided in four regions: North East, North West, Center and South. In the North West region, 98% of the surveyed individuals eat the "Azufrado" types (sulphur yellow); in the North East, 70% of the consumers prefer "pinto" (beige with brown mottles) and "Bayo" (cream) types; in the South, 90% of the consumers prefer the "Black" type; and in the Center of the country, all commercial classes are consumed. Within a commercial class, specific characteristics are demanded. For instance, in the black type, small and opaque seeds are preferred while in the "Flor de mayo" (Beige with pink mottles) type medium to large seeds having bright seed coat are preferred. The main characteristics utilized by consumers to select a given bean type are cooking time and flavor. It was observed that preferential classes are well established among the consumers since 70% responded that they would not change the preferred class even if the alternative class was sold to a lower price. Consumers do not soak the beans, because it changes the flavor and the aspect of the cooked beans and they do not add salt at the beginning of the cooking process due to the same reason. Organoleptic studies conducted in the laboratory confirmed that soaking of beans or addition of salts in the soaking water or at the beginning of the cooking process negatively affected acceptability of cooked beans by panelists. In this paper aspects related to ways of processing and consuming common beans as well as marketing aspects are discussed.

Fabaceae↗
PubMed1985

Chiropractic and the clinical art.

Chiropractic is the largest 'unorthodox' health profession in the U.S.A. It is licensed in all 50 states and its services are covered by governmental and private health insurance. Yet chiropractic remains, in the opinion of medical commentators, an unscientific healing cult. Chiropractic holds that much illness is caused, directly or indirectly, by derangements in homeostasis that result from subtle vertebral malalignments called 'subluxations'. Only a minority of 'straight' chiropractors continue to provide spinal manipulation as their only modality, while the majority 'mixers' have embraced physical therapy, vitamin supplements and a wide variety of drugless treatments. Clinical trials suggest that spinal manipulation itself has short-term benefit in back pain, but the success of chiropractic is not fully explained by that effect. The clinical art, though, as manifested in the chiropractor-patient interaction contributes greatly to chiropractic healing. This process promotes patient acceptance and validation, fulfills expectations, provides explanations and engages the patient's commitment. The same process lies at the core of the 'art of medicine'. Seeing the clinical art as it functions in chiropractic can help us to understand its independent power in medicine.

Back Pain↗
PubMed2005

Validity of process indicators of screening for breast cancer to predict mortality reduction.

The aim of the study was to empirically assess the acceptable levels of process indicators as described in the European Community Guidelines using materials from the mammography service screening programmes. The Finnish programme was evaluated for effectiveness with a prior estimate of 0.74 for RR in Finland and 0.81 in Helsinki. Hence, the Finnish programme was likely to be somewhat less effective in terms of reduction in mortality than implied on the basis of early randomized trials, but probably approaching the same level of effectiveness. Finland therefore provides background data on the applicability of the process indicators that are indicators of performance and surrogates for effectiveness. The performance data on 10 Finnish screening centres at subsequent screens were used. These centres invited 687,000 women aged 50-64 years in 1991-2000. The mean compliance was 93% and the corresponding recall rate was 2.3%. The benign to malignant biopsy ratio was 0.43:1. The average breast cancer detection rate was 0.36%, 2.1 compared with the background incidence. The proportion of screen-detected stage II+ cancers was 26%. Most, but not all, of these process indicators met the desirable reference values of the European Community. The specific criteria of the European Community on stage distribution, rates of screen-detected cancers by stage and detection rate to background incidence may need reconsideration.

Biopsy↗
PubMed1985

Adjustment, the hands and healing.

Chiropractic is the largest "unorthodox" health profession in the United States. It is licensed in all 50 states and its services covered by governmental and private health insurance. Yet chiropractic remains, in the opinion of medical commentators, an unscientific healing cult. Chiropractic holds that much illness is caused, directly or indirectly, by derangements in homeostasis that result from subtle vertebral malalignments called "subluxations". Only a minority of "straight" chiropracters continue to provide spinal manipulation as their only treatment, while the majority "mixers" have embraced physical therapy, vitamin supplements and a wide variety of drugless symptomatic treatments. Clinical trials suggest that spinal manipulation has short-term benefit in back pain, but the success of chiropractic is not fully explained by that effect. The clinical art, though, as manifested in the chiropractor-patient interaction contributes greatly to chiropractic healing. This process promotes patient acceptance and validation, fulfills expectations, provides explanations and engages the patient's commitment. The same process lies at the core of the "art of medicine". Seeing the clinical art as it functions in chiropractic can help us to understand its independent power in medicine.

Back Pain↗
PubMed2003

Validation and acceptance of new and revised tests: a flexible but transparent process.

Scientific validation is a necessary prerequisite for the regulatory acceptance of new toxicological tests, and for acceptance as Organisation for Economic Co-operation and Development Test Guidelines. Validation is defined as the determination of the reliability and relevance of a test method for a particular purpose. Reliability refers to the reproducibility of the test within and among laboratories. The relevance of a test addresses how well it measures or predicts what it is supposed to measure or predict. There are no fixed values for how reliable or relevant a test should be. Acceptable values depend on the type of test, the inherent variability in the biological systems used, and what regulatory decisions the test will be asked to support. The validation of in vitro and in vivo tests should follow the same general principles. The validation process should be flexible, according to the type of test being evaluated and its proposed uses. If a test is designed to replace a test currently in use, its reliability and relevance should be measured against that reference test or against the effect that the test is designed to predict. For the evaluation of health effects where adequate human data are available, the performance of the new test should be measured against the relevant effect in humans, rather than a surrogate species. All proceedings from the validation process and the subsequent peer-review of the method should be transparent, i.e., publicly available. It is also recommended that the peer-review of the validation study be accessible to the interested public.

Guidelines as Topic↗
PubMed1991

Biosensors for process control.

Biosensors have been extensively studied during the last 20 years, and a myriad of laboratory biosensors have been developed. Improvements are required in biosensor design and performance before they become widely accepted in industrial process monitoring. However, as the biotechnology industry expands, biosensors may become more acceptable because, despite their limitations, they are the only devices capable of delivering the information required.

Biosensing Techniques↗
PubMedDate not supplied

The ICF as a framework for national data: the introduction of ICF into Australian data dictionaries.

PURPOSE: A country's data may influence and inform its policy and services, if suitably designed. This paper describes how two related and interacting activities--work on disability concepts and classification as well as the preparation of national data dictionaries--have been carried out in Australia, with this purpose. METHOD: Three key ingredients were combined. A broadly based advisory group was established to ensure the use of disability concepts that are meaningful not only to policy makers but also to the Australian community. This group advised on two 'twin' activities: participation in the revision of the key international classification for disability, and specification of data elements for a national data dictionary according to international standards. RESULTS: National data elements were developed, based on the Beta-2 draft ICIDH-2, and accepted for use in Australian national data dictionaries on a trial basis. CONCLUSION: The purpose and process have been accepted as valuable, and there is interested anticipation of new Australian standard data elements based on the ICF.

Activities of Daily Living↗
PubMed1999

The future of physician profiling.

Although enthusiasm for physician profiling dates back to the origins of scientific medicine, the track record of profiling as an intervention is not strong. Profiling appears to be most valuable for simple interventions and processes, but its acceptance, usefulness, and impact will be influenced by future trends. Health care organizations will continue to be complex, and multiple overlapping profiles will be the norm. Technology will advance, but concerns over privacy and confidentiality will influence the social, political, and regulatory approaches to profiling. Public sector purchasers and consumers will increasingly demand profiling, but data will continue to lack the ability to interpret complex profiling data. Medical practice will increasingly accept profiling as part of ongoing quality improvement efforts, but profiling may become focused on key processes, not outcomes. Statistical, cognitive, and epistemological challenges to profiling will remain, and profiling may simultaneously become more complex and more simplified with the rise of information brokers. Greater attention to the human side of profiling will enhance its effectiveness.

Data Collection↗
PubMed2001

Women's experience following a cardiac event: the role of the self in healing.

This study explored the role of the self in the experiences of women living with cardiovascular disease. The study, which used a naturalistic design, involved interviewing 13 women with a diagnosis of coronary heart disease (CHD) and analyzing their reports through constant comparative analysis. For women, living with CHD was characterized by changing images of the self. Women reported engaging in processes involving seeking meaning, creating mastery, and accepting the self. These processes were marked by the overarching theme of connectedness with significant others. The study findings enhance understanding of the role of the self in recovery for women with diagnosed CHD.

Adaptation, Psychological↗