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PubMed2000

Effectiveness of a decentralized, community-related approach to reduce cardiovascular disease risk factor levels in Germany.

AIMS: Conventional community-oriented prevention programmes have been moderately successful in reducing cardiovascular disease risk factor levels in the population. Within the German Cardiovascular Prevention Study, a new decentralized and community-related form of preventive intervention was tested. METHODS AND RESULTS: Interested lay people and general practitioners co-operated in developing activities conducive towards a healthier lifestyle in two towns. Changes in risk factor levels were evaluated by repeated surveys of independent cross-sectional samples in two intervention communities (n=3460, baseline; 2561, final). National survey data (n=4788, baseline; 5311, final) were used to describe secular trends. Six years after the onset of intervention activities the following changes in risk factor prevalence for both sexes combined were observed in the intervention communities (95% CI in brackets): smoking -10.5% (-17.6 to -3.4); hypertension -29.0% (-38.1 to -19. 9); total cholesterol >/=250 mg. dl(-1)-8.1% (-15.4 to -0.9). In contrast to a national increase in the prevalence of obesity, this rate remained stable in the intervention communities. CONCLUSION: Initiating preventive activities developed by community members under the responsibility of local doctors is effective in lowering cardiovascular risk factors at community level. Unlike traditional intervention programmes this new approach does not require external funding and guidance.

Adult↗
PubMed1995

Decentralized lab testing. A collaborative approach to point of care testing.

What is involved in setting up and managing a decentralized laboratory testing program at a hospital? What elements are involved in making such a program a success? Multidepartmental and multidisciplinary cooperation and communication are the keys to implementing a cost-effective, user-friendly system that assures quality patient care and operator competence.

Blood Glucose↗
PubMed2001

Financial priorities under decentralization in Uganda.

This paper explores changes to budget allocations for health during the decentralization process in UGANDA: When the districts were given the authority to allot their own budgets, allocations for health were reduced considerably. The rationale for this by district leaders is investigated and analyzed. Their criteria for budget allocations for health are often based on views different to those held at central level, hence there can be conflict between the two. The mechanisms instituted by central government in reaction to what was perceived as a lack of local support to the health sector are described. In conclusion, while conditional funding may be a useful short-term step, long-term development requires less conditionalities. Health professionals need to work closely with local leaders and district officials to make health a political priority in order to develop and allocate resources for health at local level.

Budgets↗
PubMed2002

Exemptions and waivers from cost sharing: ineffective safety nets in decentralized districts in Uganda.

The introduction of user-payment for health services is frequently followed by concern about the impact on equity of access for poor people. Decentralizing governments often try to remedy the created inequities by putting in place safety nets in the form of exemptions and waivers in the user-fee systems. However, where user payments merely operate as local government strategies for health financing, without national policy they are likely to be self-defeating, as local governments are frequently more interested in raising revenue to meet recurrent costs of devolved services than in promoting equity. Thus guidelines put in place by the central government to operationalize safety nets are seen by local governments as being contradictory to this goal, and are thus ignored or altered to suit the district revenue aims. This study was carried out to investigate the context and the constraints in implementing exemption schemes. Data were collected in two selected administrative districts of Uganda (Mbarara and Mukono). Qualitative approaches to data collection were adopted, namely focus group discussions and key informant interviews with policy-makers, health administrators, service providers and community members. These methods were combined with document review. We found little evidence of safety-net guidelines initiated by decentralized/local governments, since district local governments had little motivation to extend exemptions, waivers or credits. The conclusion is that safety nets such as waivers and exemptions will only be effective if they are backed by a national health financing policy, they reconcile the often competing demands of local government revenue needs, and are strictly enforced and supervised by both the local and central governments. The implications of the findings for remedying the tension between the needs for cost recovery and for attainment of equity goals through exemption policies for the poor and indigent are discussed.

Cost Sharing↗
PubMed2005

Bypassing districts? Implications of sector-wide approaches and decentralization for integrating gender equity in Uganda and Kenya.

While the concept of gender mainstreaming has gained acceptance among many national and international development organizations, many obstacles are faced in translating the concept into tangible improvements in the health and well-being of women and men. This paper presents two qualitative case studies, one from Kenya and one from Uganda, of experiences of mainstreaming gender at district level; experiences which are set against the context of decentralization and sector-wide approaches (SWAPs). The conceptual framework of social movement theory, as used by Hafner-Burton and Pollack, is drawn upon to analyze the findings of both case studies. This paper has been written in conjunction with a paper by Theobald et al. which explores gender mainstreaming at national level.

Female↗
PubMed1997

Effects of PACAP-38 on the SA nodal pacemaker activity in autonomically decentralized hearts of anesthetized dogs.

Pituitary adenylate cyclase-activating polypeptide (PACAP) receptors exist, but the physiologic role of PACAP is unclear in the heart in situ. We investigated effects of PACAP-38 on sinus rate and on the negative chronotropic response to acetylcholine (ACh) or stimulation of the intracardiac parasympathetic nerve fibers to the sinoatrial nodal region in the automatically decentralized heart of the open chest, anesthetized dog. PACAP-38 (0.1-1 nmol) injected directly into the sinus node artery caused transient positive followed by negative chronotropic responses. Both pretreatment with atropine and tetrodotoxin inhibited the negative chronotropic responses to PACAP-38. However, hexamethonium did not block the negative responses to PACAP-38. After treatment with PACAP-38 (0.1-1 nmol), ACh induced atrial fibrillation significantly (p < 0.01). On the other hand, the negative chronotropic responses to intracardiac parasympathetic stimulation were not changed. These results suggest that (a) PACAP-38 induces negative chronotropic responses and liberates ACh from intracardiac postganglionic parasympathetic nerves, and that (b) PACAP-38 reduces ACh-induced atrial fibrillation threshold in the dog heart in situ.

Acetylcholine↗
PubMed1989

Influence of lens vertex distance changes on prismatic effect and decentration.

Changing the lens vertex distance alters the effective power of a lens, both in refractive and prismatic effect. For spherical lenses under paraxial conditions, it was found that though the amount of incorporated prism should be modified in the correcting lens in cases of vertex distance changes, the actual amount of decentration should be kept constant.

Eyeglasses↗
PubMed2000

Changes in stereoscopic depth perception caused by decentration of spectacle lenses.

The effect that decentered spectacle (ophthalmic) lenses exert on depth perception has been studied, evaluating stereopsis through the disparity range (maximum horizontal disparity) for random-dot stereograms (RDS). The results show that variations in fusional convergence due to increments of decentration can diminish the stereopsis in observers, reducing the region within which stereoscopic correspondence can take place. Decreases in disparity ranges were found for vertical and horizontal prismatic effects, although the prismatic effect necessary for this was less in the vertical case. A decreased disparity range has also been confirmed with figural-stimuli stereograms and using prisms for generating the prismatic effects.

Adaptation, Ocular↗
PubMedDate not supplied

Six hospitals describe decentralization, cost containment, and downsizing.

Decentralization, cost containment, and downsizing continue in full force as healthcare organizations continue to adapt to constant economic change. Hospitals are forced to take a second and third look at how health care is managed in order to survive. Six Northwest Florida hospitals were surveyed in an effort to explore current changes within the healthcare delivery system. This article provides both managers and staff with an overview of recent healthcare changes in an area of the country with implications for staff development.

Attitude of Health Personnel↗
PubMed2005

Coordinated decentralized adaptive output feedback control of interconnected systems.

A decentralized adaptive output feedback control design is proposed for large-scale interconnected systems. It is assumed that all the controllers share prior information about the system reference models. Based on that information, a linearly parameterized neural network is introduced for each subsystem to partially cancel the effect of the interconnections on tracking performance. Boundedness of error signals is shown through Lyapunov's direct method.

Algorithms↗
PubMed2004

Synchronization of decentralized multiple-model systems by market-based optimization.

Market-based optimization is a new optimization method for large decentralized systems where the distributed resource allocation of an economic system is adopted. Market-based algorithms can be interpreted as multi-agent scenarios where producer and consumer agents both compete and cooperate on a market of specified commodities. The market-based approach is applied to the synchronization of a set of local multiple-model systems. The method is extended to the case where each of the subsystems is represented by a Takagi-Sugeno (TS) fuzzy system. Although all local systems are provided with the same control input, the behaviors of the local systems are, in general, different because of different parameters in the subsystems. The task of the market-based optimization is to find an appropriate composition of subsystems so that all local systems exhibit a similar dynamical behavior. Examples show that even systems with potentially unstable local systems can be synchronized if there exists a stable combination of weighted subsystems.

Journal Article↗
PubMed2004

Adaptive fuzzy decentralized control for a class of large-scale nonlinear systems.

In this paper, direct and indirect adaptive output-feedback fuzzy decentralized controllers for a class of uncertain large-scale nonlinear systems are developed. The proposed controllers do not need the availability of the state variables. By designing the state observer, the adaptive fuzzy systems, which are used to model the unknown functions, can be constructed using the state estimations, and a new hybrid adaptive fuzzy control methodology is proposed by combining the adaptive fuzzy systems with H infinity control and the sliding mode control techniques. Based on Lyapunov stability theorem, the stability of the closed-loop systems can be verified. Moreover, the proposed overall control schemes guarantee that all the signals involved are bounded and achieve the H infinity-tracking performance. To demonstrate the effectiveness of the proposed methods, simulation results are illustrated in this paper.

Journal Article↗
PubMed2005

Mixed H2/H infinity design for a decentralized discrete variable structure control with application to mobile robots.

In this paper, a decentralized discrete variable structure control via mixed H2/H infinity design was developed. In the beginning, the H2-norm of output error and weighted control input was minimized to obtain a control such that smaller energy consumption with bounded tracking error was assured. In addition, a suitable selection of this weighted function (connected with frequency) could reduce the effect of disturbance on the control input. However, an output disturbance caused by the interactions among subsystems, modeling error, and external load deteriorated system performance or even brought about instability. In this situation, the H infinity-norm of weighted sensitivity between output disturbance and output error was minimized to attenuate the effect of output disturbance. Moreover, an appropriate selection of this weighted function (related to frequency) could reject the corresponding output disturbance. No solution of Diophantine equation was required; the computational advantage was especially dominated for low-order system. For further improving system performance, a switching control for every subsystem was designed. The proposed control (mixed H2/H infinity DDVSC) was a three-step design method. The stability of the overall system was verified by Lyapunov stability criterion. The simulations and experiments of mobile robot were carried out to evaluate the usefulness of the proposed method.

Algorithms↗
PubMed2005

Redundant manipulator techniques for partially decentralized path planning and control of a platoon of autonomous vehicles.

An approach to real-time trajectory generation for platoons of autonomous vehicles is developed from well-known control techniques for redundant robotic manipulators. The partially decentralized structure of this approach permits each vehicle to independently compute its trajectory in real-time using only locally generated information and low-bandwidth feedback generated by a system exogenous to the platoon. Our work is motivated by applications for which communications bandwidth is severely limited, such for platoons of autonomous underwater vehicles. The communication requirements for our trajectory generation approach are independent of the number of vehicles in the platoon, enabling platoons composed of a large number of vehicles to be coordinated despite limited communication bandwidth.

Algorithms↗
PubMed2004

Factors impacting on nurse managers' ability to be innovative in a decentralized management structure.

Several studies indicate that management styles and knowledge of organizational structures have an impact on the potential for staff innovation. This exploratory study was conducted to investigate the implications of such variables in relation to nursing managers in a public sector health organization in Victoria, Australia. It reviewed factors that appeared to impact and encourage innovative behaviour amongst nurse managers within a decentralized management structure. To evaluate nurse managers' ability to be innovative, a 55-item survey consisting of both open questions and Likert-type scale questions was developed and distributed to 140 nurse managers working in a public sector health organization. The response rate was 58% yielding 82 usable responses. The study findings revealed that factors of management structures and management styles, in conjunction with the nurse unit managers' perceptions and communication skills, had an impact on nurse manager's ability to exhibit innovative behaviour in the 21st century workplace.

Attitude of Health Personnel↗
PubMed1995

Developing decentralized capacity for disaster prevention: lessons from food security and nutrition monitoring in Malawi.

Lack of sufficient analytical capacity in most of the countries of sub-Saharan Africa has been frequently mentioned as a major factor limiting the effectiveness of drought management interventions. In this article we describe an approach used in Malawi for the past three years to develop a decentralized capacity to analyse drought management and disaster prevention programmes. A conceptual framework is presented which identifies the areas in which capacity strengthening is required and lessons from the Malawi experience are presented. Various issues relating to the efficiency of capacity building programmes are discussed. We argue that continuous dialogue between development researchers and decision-makers, and between trainers in academic institutions and donor agencies, is essential for achieving the goals of improved capacity for drought management and disaster prevention.

Disaster Planning↗