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PubMed2002

Developing a performance improvement program.

In today's health care environment, the focus has shifted to quality in every aspect of patient care, with this emphasis coming from patients, employers, insurance companies, and regulatory and accreditation agencies. Developing a performance improvement (PI) program to document quality of care can promote a safe environment and improve patient outcomes. There are helpful resources such as the Web, books, magazines, and continuing education resources that can provide structure and guide in the development of the PI program.

Ambulatory Surgical Procedures↗
PubMed2001

Bed rationing and allocation in the intensive care unit.

That the resources available for intensive care cannot be infinite is self-evident. Parallel increases in medical capability, cost, and community expectations have forced intensivists to confront the reality of resource limitation. Traditional bioethical structures cope poorly with this focus beyond the traditional patient-doctor relationship. Allocation of funds for intensive care may be case-based, historically based, per diem, or capitation-based but is always heavily influenced by political and economic considerations. Attempts have been made to relate costs to severity or intervention scores, but all these techniques are limited by the high fixed costs of intensive care. Methods available to help the physician faced with patient-selection dilemmas include cost-effectiveness and cost-utility analysis. These techniques involve assessment of the quality of life with the help of several well-validated quantitative approaches. Choosing between competing patients for intensive care beds is often more a theoretical issue than a practical one, because alternative arrangements can almost always be made. Physicians have an ethical and social responsibility to further develop the tools to inform community debate on these issues.

Ethics, Medical↗
PubMed2005

Inference and analysis of haplotypes from combined genotyping studies deposited in dbSNP.

In the attempt to understand human variation and the genetic basis of complex disease, a tremendous number of single nucleotide polymorphisms (SNPs) have been discovered and deposited into NCBI's dbSNP public database. More than 2.7 million SNPs in the database have genotype information. This data provides an invaluable resource for understanding the structure of human variation and the design of genetic association studies. The genotypes deposited to dbSNP are unphased, and thus, the haplotype information is unknown. We applied the phasing method HAP to obtain the haplotype information, block partitions, and tag SNPs for all publicly available genotype data and deposited this information into the dbSNP database. We also deposited the orthologous chimpanzee reference sequence for each predicted haplotype block computed using the UCSC BLASTZ alignments of human and chimpanzee. Using dbSNP, researchers can now easily perform analyses using multiple genotype data sets from the same genomic regions. Dense and sparse genotype data sets from the same region were combined to show that the number of common haplotypes is significantly underestimated in whole genome data sets, while the predicted haplotypes over the common SNPs are consistent between studies. To validate the accuracy of the predictions, we bench-marked HAP's running time and phasing accuracy against PHASE. Although HAP is slightly less accurate than PHASE, HAP is over 1000 times faster than PHASE, making it suitable for application to the entire set of genotypes in dbSNP.

Animals↗
PubMed2002

The Nucleic Acid Database.

The Nucleic Acid Database was established in 1991 as a resource to assemble and distribute structural information about nucleic acids. Over the years, the NDB has developed generalized software for processing, archiving, querying and distributing structural data for nucleic acid-containing structures. The architecture and capabilities of the Nucleic Acid Database, as well as some of the research enabled by this resource, are presented in this article.

Computer Graphics↗
PubMed2005

Sequential information processing using time-delay connections in ontogenic CALM networks.

In this paper, a variant of the categorization-and-learning-module (CALM) network is presented that is not only capable of categorizing sequential information with feedback, but can adapt its resources to the current training set. In other words, the modules of the network may grow or shrink depending on the complexity of the presented sequence-set. In the original CALM algorithm, modules did not have access to activations from earlier stimulus presentations. To bypass this limitation, we introduced time-delay connections in CALM. These connections allow for a delayed propagation of activation, such that information at a given time will be available to a module at a later timestep. In addition, modules can autonomously add and remove resources depending on the structure and complexity of the task domain. The performance of this ontogenic CALM network with time-delay connections is demonstrated and analyzed using a sample set of overlapping sequences from an existing problem domain.

Algorithms↗
PubMed1983

Leadership, nurses and the 1980s.

The author examines some of the reasons for the leadership problems in nursing by focusing on the question of 'why leaders are not leading'. Drawing on James MacGregor Burns' general theory of political leadership, the article examines issues of motives, resources, followers and the structure of nursing today.

Canada↗
PubMed2006

Model testing on the crisis interventions and actions to prevent medical disputes: a Taiwanese nursing perspective.

AIMS AND OBJECTIVES: This study investigated the contributions of comprehensiveness and necessity scales on crisis interventions and actions toward nursing practice-related medical disputes in Taiwanese hospitals and institutions' demographic characteristics, to overall satisfaction toward nursing-related crisis management policies and interventions and overall satisfaction toward their institution's crisis management system. BACKGROUND: In a health-care environment that is focused on cost containment, for overworked nurses and understaffed medical wards, patients still expect nurses to provide high quality, compassionate care. Patients usually regard nurses as the principal link between the technical and interpersonal aspects of their care. However, current hospital systems tend to require patients to be self-reliant in managing their own care. Patient mistrust of medical care providers might have contributed to the current medical error/dispute crisis. METHODS: In this cross-sectional study, the subjects were nursing directors of Taiwanese hospitals (197 valid subjects). The author developed the questionnaire used in this study. RESULTS: The ordinal logistic regression analyses demonstrated that being a public hospital managed by the government, being a hospital operated by a corporate body, the more comprehensive the technical/structural aspect and the assessment aspect and the more needed the psychological aspect, contribute to higher general satisfaction levels toward nursing-related crisis management. The more comprehensive the strategic aspect and having more acute beds, contributes to higher satisfaction levels with their institution's overall crisis management activities. CONCLUSIONS: These findings inferred a possible change in a hospital's resource allocation or power structure when dealing with issues of patient care quality, including nursing practice-related crisis management policies, interventions and actions. RELEVANT TO CLINICAL PRACTICE: A good crisis management system may help to keep a crisis from worsening, which might lead to a serious situation that includes malpractice litigation. It is believed that the questionnaire used in this study may be used as a diagnostic tool for assessing a crisis management system within a hospital's nursing environment.

Attitude of Health Personnel↗
PubMed2005

Health innovation networks to help developing countries address neglected diseases.

Gross inequities in disease burden between developed and developing countries are now the subject of intense global attention. Public and private donors have marshaled resources and created organizational structures to accelerate the development of new health products and to procure and distribute drugs and vaccines for the poor. Despite these encouraging efforts directed primarily from and funded by industrialized countries, sufficiency and sustainability remain enormous challenges because of the sheer magnitude of the problem. Here we highlight a complementary and increasingly important means to improve health equity: the growing ability of some developing countries to undertake health innovation.

Biomedical Research↗
PubMed2002

Functional comparison of serine protease autotransporters of enterobacteriaceae.

The plasmid-encoded toxin (Pet) of enteroaggregative Escherichia coli (EAEC) belongs to a family of high-molecular-weight serine protease autotransporters of Enterobacteriaceae (SPATEs) which also includes Pic from EAEC and Shigella flexneri, EspC from enteropathogenic E. coli, EspP from enterohemorrhagic E. coli, Sat from uropathogenic E. coli, Tsh from avian pathogenic E. coli, and SepA from S. flexneri. Phylogenetic analysis shows the SPATE proteins to represent a distinct subfamily of autotransporters with amino acid identities ranging from 35 to 55%, providing a powerful resource to direct structure-function studies. In this study, we show that these related proteins are proteases with divergent substrate specificities, suggesting different functions. The cleavage profile of oligopeptides was found to be unique for each SPATE protein. The SPATEs showed proteolytic activity for several substrates, namely mucin, pepsin, human coagulation factor V, and erythroid spectrin. The cleavage of spectrin has been hypothesized as the mechanism through which Pet induces cytopathic effects. However, whereas Pet, Sat, and EspC cleaved spectrin, only Pet and Sat elicited cytopathic effects; the remaining SPATEs did not cause any morphological changes to HEp-2 cell monolayers. EspC and Pet exhibited acid-dissociable binding to HEp-2 cells. However, Pet was more efficient at entering HEp-2 cells, suggesting a basis for the different abilities of these two proteases to damage cells. Our data suggest that, despite the homologies observed among these proteins, the SPATEs have different pathogenetic functions only partly dependent on their substrate specificities.

Bacterial Proteins↗
PubMed2005

Weighing both sides: morality, mortality, and framing contests over obesity.

Despite recent and growing media attention surrounding obesity in the United States, the so-called obesity epidemic remains a highly contested scientific and social fact. This article examines the contemporary obesity debate through systematic examination of the claims and claimants involved in the controversy. We argue that four primary groups-antiobesity researchers, antiobesity activists, fat acceptance researchers, and fat acceptance activists-are at the forefront of this controversy and that these groups are fundamentally engaged in framing contests over the nature and consequences of excess body weight. While members of the fat acceptance groups embrace a body diversity frame, presenting fatness as a natural and largely inevitable form of diversity, members of the antiobesity camp frame higher weights as risky behavior akin to smoking, implying that body weight is under personal control and that people have a moral and medical responsibility to manage their weight. Both groups sometimes frame obesity as an illness, which limits blame by suggesting that weight is biologically or genetically determined but simultaneously stigmatizes fat bodies as diseased. While the antiobesity camp frames obesity as an epidemic to increase public attention, fat acceptance activists argue that concern over obesity is distracting attention from a host of more important health issues for fat Americans. We examine the strategies claimants use to establish their own credibility or discredit their opponents, and explain how the fat acceptance movement has exploited structural opportunities and cultural resources created by AIDS activism and feminism to wield some influence over U.S. public health approaches. We conclude that notions of morality play a central role in the controversy over obesity, as in many medical disputes, and illustrate how medical arguments about body weight can be used to stymie rights claims and justify morality-based fears.

Attitude to Health↗
PubMed2026

ERGA-BGE reference genome of the Eurasian Woodcock ( Scolopax rusticola), a game bird species with isolated populations of conservation interest.

The reference genome of the Eurasian Woodcock ( Scolopax rusticola) is an important resource to investigate population structure across the wide breeding range of this iconic game species and the conservation status of specific management units, such as the isolated Macaronesian populations. The genome sequence was assembled into 45 contiguous chromosomal pseudomolecules and 2 sex chromosomes (W and Z). This chromosome-level assembly encompasses 1.2 Gb, composed of 1,613 contigs and 935 scaffolds, with contig and scaffold N50 values of 5.9 Mb and 34.2 Mb, respectively.

Aves↗
PubMedDate not supplied

Changing NHS structures: implications for nursing careers.

This article explores what implications the flatter NHS structures (after the restructuring of April 1999) might have for nursing careers. It examines issues of recognition, reward systems and career pathways and the problems these may pose for the retention of qualified staff within nursing. It is seen that flatter structures will offer little in the way of traditional vertical promotion opportunities and readers are invited to explore the possibility of lateral promotion, continuous development, career grids and the rise of the generic nurse. Speculation about the introduction of competency-based pay systems is introduced. The article attempts to progress the debate in the area of the links between structure and supporting human resource infrastructures within the public sector set against background context of severe cash constraints. It seeks to raise the issues and open debate among practitioners.

Career Mobility↗
PubMed2005

The landscape in global tobacco control research: a guide to gaining a foothold.

Smoking prevalence is shifting from more- to less-developed countries. In higher-income countries, smoking surveillance data, tailored treatments, public health campaigns, and research-based policy implementation have led to a decrease in tobacco use. In low- and middle-income countries, translating research into practice and policy is integral for tobacco control. We describe the landscape of existing resources, both financial and structural, to support global tobacco control research and strengthen research capacity in developing countries. We identify key organizations that support international efforts, provide examples of partnerships between developed and developing countries, and make recommendations for advancing global tobacco research. There is a need for increased commitment from organizations to support global tobacco control research.

Biomedical Research↗
PubMed2002

Roots, shoots, but too little fruit: assessing the contribution of COPC in South Africa.

Community-oriented primary care (COPC) originated in South Africa during the 1940s and 1950s, where it served to inform local church-based and nongovernmental organization-based initiatives during the apartheid years. During the 1990s, COPC played an inspirational role in the process of national health policy formulation. Yet COPC's contribution to current health practice remains more symbolic than substantive. Despite a policy framework that favors the widespread introduction of COPC, various political, structural, managerial, and human resource obstacles constrain its effective implementation. Notwithstanding a rapidly changing health care environment and well-established health transition from infections and nutritional disorders to non-communicable diseases and injury, COPC and its variants remain abidingly relevant to South Africa's-and Africa's-health care reality.

Community Health Centers↗
PubMed2006

Effects of influent COD/N ratio and internal recycle ratio on nitrogen removal efficiency in the KNR process.

In this study, with the KNR process that has many advantages, the nitrogen removal efficiency of KNR was experimentally investigated at various COD/N ratios of influent conditions. The optimal operating condition of internal recycle ratio was evaluated. The TN removal efficiencies were 59.1, 72.5 and 75.9% at the COD/N ratios of 3, 5 and 7, respectively. These high removal efficiencies resulted from high denitrification rate in UMBR with high microorganism concentration. Furthermore, specific endogenous denitrification at MLVSS of 10.3 g/L that is similar to MLVSS in UMBR was over two times higher than that at MLVSS of 2.06 g/L. This result suggests that endogenous denitrification rate in UMBR is so high that the requirement of an external carbon source can be saved. As the internal recycle ratio increased from 100 to 400%, the TN removal efficiency also improved from 69.5 to 82.9%, and the optimal internal recycle ratio was 300%.

Aerobiosis↗
PubMed2004

Finding the way: a model for educational system analysis.

Administrators new to an academic setting experience a steep learning curve in finding their way around the organization. Leadership strategies that have proven effective in a previous setting or in another role may not be appropriate to or effective in the new setting. Disruptive effects of such leadership transitions can be minimized if newly employed administrators take a systematic approach to learning about the organization. The educational systems analysis model (ESAM) described here provides direction for new academic administrators in rapid analysis of a nursing education program. ESAM is comprised of both external and internal elements that influence system operation and the role of the administrator within the system. External elements include environmental factors that influence the program as well as the community of interest. Internal elements include the mission and goals, culture, relationships, structure, programs and services, resources, and outcomes of the program. Each of the internal elements is considered from both content and process perspectives. Relationships among the elements in the model are dynamic and reciprocal.

Administrative Personnel↗
PubMedDate not supplied

New role of a medical documentation system.

Architecture of a new medical documentation system (MDS) is proposed. First, we studied the traditional MDS in terms of organizational structure, main functions, means (resources) and personnel. Special emphasis is given to the information retrieval (IR) system which is the kernel of a MDS. Then, some achievements of information technology is summarized, and concept of a mixed IR system which is the kernel of the new system is presented. New architecture is then presented. Units which compose the entire system are: host documentation centre, local documentation centres, and documentation units. Eventually, objective and features of every part are discussed.

Database Management Systems↗
PubMed1986

Balancing challenge and responsibility: a suggested role for graduate programs in addressing career development.

This article suggests a role graduate programs might adopt to meet the challenge of counseling students to take advantage of new career opportunities, not just relying on the allegiances that easily led graduates into traditional careers. It proposes a two-stage approach consisting of sets of nurturing activities--to help students arrive at well understood, personal professional missions, and facilitating activities--to support advancing those professional missions. In view of limited academic resources and faculty reward structures that primarily acknowledge scholarly productivity, not student service, synergy is essential. Its achievement may require marshalling contributions from students, faculty, alumni and other practitioners, and professional associations. While requiring substantial initial investment of faculty energy, the returns may benefit students, faculty, and program alike.

Career Mobility↗