Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Decentralization”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources
PubMed1994

Temporal analysis of the anti-inflammatory effects of decentralization of the rat superior cervical ganglia.

Bilateral decentralization of the superior cervical ganglia (SCG) reduced the pulmonary inflammation that develops 4-8 h after induction of anaphylaxis in Nippostrongylus brasiliensis-sensitized rats. Histamine levels in peritoneal lavage fluid and rat mast cell protease type II in serum were increased to comparable levels in sham-operated and decentralized rats. In vitro stimulation of alveolar macrophages (ALM) with lipopolysaccharide (LPS) provoked tumor necrosis factor-alpha (TNF-alpha) release that was two to three times greater with unchallenged decentralized rats than with sham-operated rats. However, after allergen challenge LPS-stimulated TNF-alpha release from ALM of sham-operated rats increased threefold and lasted at least 24 h, whereas with decentralized rats release of this cytokine actually decreased at 4 and 8 h. The increase in the phagocytosis and respiratory burst of circulating neutrophils seen at 4 and 8 h after allergen challenge in sham-operated rats was reduced significantly by decentralization. These results suggest that the attenuation of anaphylaxis-induced pulmonary inflammation that occurs with decentralization of the SCG is primarily associated with downregulation of neutrophil and macrophage functions.

Anaphylaxis↗
PubMed1975

The state mental hospital in transition. Illinois state mental hospitals decentralize.

In this paper, we have looked at mental hospital decentralization as it has developed in the thirteen State of Illinois mental hospitals as of June 30, 1967. The hospitals were looked at from the most centralized to the most decentralized. This was done by relating the hospitals to five descriptive model types, described at greater length elsewhere. Hospital decentralization is portrayed as a complex and highly idiosyncratic process. Attempts to place specific hospitals at point along the decentralization continuum are thus tentative and clear rules for classifying stages of decentralization have yet to be formulated. Complicating the picture still further is that hospitals in transition change rapidly and may at even intervals of a month show dramatic change. It is expected that the trend implied is stable, however, and that ultimately all Illinois state mental hospital with possible exception of ISPI and Illinois Security Hospital, will be located at the decentralized model. This is seen as necessary if they are to survive as viable treatment institutions.

Commitment of Persons with Psychiatric Disorders↗
PubMed1986

Time course of the development of pre- and postjunctional supersensitivity in the rabbit ear artery after decentralization.

Changes in the sensitivity of the rabbit ear artery to exogenous norepinephrine and potassium and to sympathetic nerve electrical stimulation were examined in vitro following decentralization which was performed by removing the unilateral preganglionic nerve proximal to the superior cervical ganglion. The contralateral side was left intact as a control. The postjunctional supersensitivity to exogenous norepinephrine and potassium had fully developed one week after the decentralization and was sustained for at least 8 weeks; the arteries decentralized for 1-8 weeks were about 2.1- and 1.3-fold supersensitive to norepinephrine and potassium, respectively, as compared with the contralateral control arteries. The frequency-response curve of the electrically stimulated decentralized artery shifted gradually to the left of the control within weeks after decentralization. Since the response to electrical stimulation was attributed to endogenous norepinephrine released from the sympathetic nerve terminals within the adventitial-medial junction, the leftward shift of the frequency-response curve in the decentralized artery probably reflects a gradual increase in the released norepinephrine per pulse by electrical stimulation, i.e., the prejunctional supersensitivity to electrical stimulation. It is concluded that the prejunctional sympathetic supersensitivity to electrical stimulation develops slower than the postjunctional nonspecific supersensitivity in the rabbit ear artery. The change in the sensitivity of the denervated postganglionic neuron, including the superior cervical ganglion is also discussed with regard to the "law of denervation supersensitivity".

Animals↗
PubMed1993

Release of sympathetic neurotransmitter evoked by electrical stimulation is increased in the chronically decentralized artery.

The present study was performed to confirm our previous proposal that the increase in neurotransmitter release is responsible for the supersensitivity of chronically decentralized artery to transmural nerve stimulation (TNS) in the rabbit. The ear artery was decentralized unilaterally by removing the preganglionic fiber proximal to the superior cervical ganglion (SCG), and the ear arteries and SCG were dissected 8 weeks after the operation. The increase in the tritium overflow induced by TNS from the chronically decentralized artery, which had been incubated with 3H-noradrenaline (NA) for 1 hr, was markedly increased at lower frequencies (0.1 and 0.2 Hz) than that from the control artery, whereas there was no difference at higher frequencies (> 0.5 Hz). No difference was observed in the neuronal uptake of 3H-NA during incubation for 1 hr between the control and decentralized arteries. There was also no change in the contents of catecholamines in both the artery and SCG after chronic decentralization, when assayed by a radioenzymatic procedure. In conclusion, the results obtained indicate that the supersensitivity to TNS after chronic decentralization is not due to the deranged catecholamine uptake and storage mechanisms in adrenergic nerve terminals and augmented transmitter biosynthesis, but due to the increased release of transmitter in response to low frequencies of TNS.

Animals↗
PubMed1992

Decentralization of the superior cervical ganglia and the immediate hypersensitivity response.

Bilateral decentralization of the superior cervical ganglia protects against pulmonary inflammation when measured 8 hr after induction of anaphylaxis in rats sensitized to the nematode, Nippostrongylus brasiliensis. Since anaphylactic shock produces immediate perturbations to the cardiovascular and respiratory systems, we examined whether bilateral decentralization of the superior cervical ganglia modified the responses of these two systems during the first 4 hr of the anaphylactic response. With the exception of the bronchioles, decentralization did not protect against anaphylaxis-associated increases in extravasation of albumin, and the small changes in respiratory function induced by anaphylaxis were unaffected by the denervation. Decentralization did not alter anaphylaxis-induced reductions in blood flow to the gastrointestinal tract; however, blood flow to the kidneys and spleen of decentralized rats was restored more rapidly to normal values. These results suggest that the protective effect of decentralization on the late phase pulmonary inflammation of anaphylaxis is unrelated to early changes in respiratory mechanics, although the protection may be facilitated by the more rapid re-establishment of normal cardiovascular homeostasis.

Analysis of Variance↗
PubMed2001

Long-term maintenance of channel distribution in a central pattern generator neuron by neuromodulatory inputs revealed by decentralization in organ culture.

Organotypic cultures of the lobster (Homarus gammarus) stomatogastric nervous system (STNS) were used to assess changes in membrane properties of neurons of the pyloric motor pattern-generating network in the long-term absence of neuromodulatory inputs to the stomatogastric ganglion (STG). Specifically, we investigated decentralization-induced changes in the distribution and density of the transient outward current, I(A), which is encoded within the STG by the shal gene and plays an important role in shaping rhythmic bursting of pyloric neurons. Using an antibody against lobster shal K(+) channels, we found shal immunoreactivity in the membranes of neuritic processes, but not somata, of STG neurons in 5 d cultured STNS with intact modulatory inputs. However, in 5 d decentralized STG, shal immunoreactivity was still seen in primary neurites but was likewise present in a subset of STG somata. Among the neurons displaying this altered shal localization was the pyloric dilator (PD) neuron, which remained rhythmically active in 5 d decentralized STG. Two-electrode voltage clamp was used to compare I(A) in synaptically isolated PD neurons in long-term decentralized STG and nondecentralized controls. Although the voltage dependence and kinetics of I(A) changed little with decentralization, the maximal conductance of I(A) in PD neurons increased by 43.4%. This increase was consistent with the decentralization-induced increase in shal protein expression, indicating an alteration in the density and distribution of functional A-channels. Our results suggest that, in addition to the short-term regulation of network function, modulatory inputs may also play a role, either directly or indirectly, in controlling channel number and distribution, thereby maintaining the biophysical character of neuronal targets on a long-term basis.

Animals↗
PubMed2002

Health sector decentralization in developing countries: unique or universal!

Experiments with decentralization began in the late 1970s and continued throughout the 1980s. decentralization was regarded as a key element of the primary health care approach. It was seen initially as having important political value that can be used as a means to enhance health service policy. However, in many instances, western donors who believe that because one form of decentralization works in developed countries, it will also work in the developing world often pursue decentralization. This paper identifies key political, managerial, technical and structural issues underpinning each individual country which vary enormously from one country to another. The relevance of experience of transfer will need to be considered with these variations in mind. The paper draws lessons from the experiences of various countries and highlights the need to approach formulation and implementation strategies for health sector reforms systematically, rather than importing, uncritically, structural models developed abroad. Political considerations are inherent in any decision made, and a political environment limits the extent of decentralization. Without doubt, the most serious mistake any reformer can make is to assume decentralization to be a managerial exercise devoid of political cause and consequences.

Community Health Planning↗
PubMed1988

Attitudes of pharmacists and nurses toward interprofessional relations and decentralized pharmaceutical services.

Pharmacists' and nurses' attitudes toward pharmacist-nurse relations and pharmaceutical services were surveyed before and after the implementation of satellite pharmacies at a 600-bed teaching hospital. The same questionnaire was distributed two months before decentralization (phase 1) and nine months after decentralization was completed (phase 2). Sixty questions about the pharmacy services and the drug treatment process were to be answered using a seven-point, Likert-type scale. Overall response rates for the two phases were 62% and 45%, respectively. Pharmacists' satisfaction with all measured aspects of pharmaceutical services increased after decentralization of services; nurses' satisfaction increased for all measures except pharmacist-conducted medication histories. Pharmacists' satisfaction with the nursing department was greater after decentralized services were implemented. Most aspects of role conflict, one of four measured antecedents to interdepartmental conflict, improved subsequent to decentralization of services. Because of changes in personnel between the two phases of the study, the results may represent the opinions of different people, rather than actual changes in satisfaction. The attitudes of nurses and pharmacists toward overall distributive pharmaceutical services and toward certain aspects of interprofessional relations improved after pharmaceutical services were decentralized.

Attitude of Health Personnel↗
PubMedDate not supplied

Financial management systems under decentralization and their effect on malaria control in Uganda.

A descriptive case study with multiple sites and a single level of analysis was carried out in four purposefully selected administrative districts of Uganda to investigate the effect of financial management systems under decentralization on malaria control. Data were primarily collected from 36 interviews with district managers, staff at health units and local leaders. A review of records and documents related to decentralization at the central and district level was also used to generate data for the study. We found that a long, tedious, and bureaucratic process combined with lack of knowledge in working with new financial systems by several actors characterized financial flow under decentralization. This affected the timely use of financial resources for malaria control in that there were funds in the system that could not be accessed for use. We were also told that sometimes these funds were returned to the central government because of non-use due to difficulties in accessing them and/or stringent conditions not to divert them to other uses. Our data showed that a cocktail of bureaucratic control systems, corruption and incompetence make the financial management system under decentralization counter-productive for malaria control. The main conclusion is that good governance through appropriate and efficient financial management systems is very important for effective malaria control under decentralization.

Financial Management↗
PubMed1982

Comparative study of supersensitivity to K+ after denervation and decentralization in rabbit ear artery.

The contractile response to potassium following denervation or decentralization of the central artery of the rabbit ear was studied in vitro. Denervation or decentralization for 8 weeks caused comparable supersensitivity to potassium: mean EC50 values obtained with isotonic high potassium solution were 21.3 mM in the denervated artery and 18.7 mM in the decentralized artery, and these values were significantly less than those (25-26 mM) of their respective contralateral control arteries (P less than 0.005, paired t-test). The maximum responses to potassium did not differ among the control, denervated and decentralized arteries. Phentolamine (3 X 10(-7) M) and propranolol (3 X 10(-7) M) had no significant effect on the response to potassium. Sensitivities to potassium with hypertonic high KCl solution and hypertonic high K2SO4 solution were virtually identical to those obtained with isotonic high potassium solution. The results suggest that denervation and decentralization produce identical postjunctional supersensitivity to potassium and that the lack of tonic activity of sympathetic nerves may be responsible for the phenomenon in the rabbit ear artery.

Animals↗
PubMed1993

The effect of chronic decentralization on the enkephalin immunoreactive plexus around penile ganglionic neurons.

Target organ responses to sympathetic nerve stimulation are altered following partial decentralization of the pelvic plexus in the rat. One possible explanation for the new responses is that nerve injury has led to a reorganization of synaptic connections within pelvic ganglia. Since one measure of synaptic influence is the occurrence of a pericellular plexus of varicose fibers around autonomic ganglion cells, the present study has used immunocytochemistry for enkephalin (ENK), a peptide present in nerve fibers in the pelvic plexus, to follow changes in the innervation of penile ganglionic neurons after interruption of preganglionic pathways. Penile ganglion cells were located by the injection of the tracer Fluorogold into the penile crura. Four days after lesion of the pelvic nerve, innervation of penile neurons falls from 76% to 20%. This number increases however, to 31% in chronically (6 weeks) lesioned animals. In the totally decentralized ganglia, ENK immunoreactive (IR) fibers enclose fewer than 12% of the penile neurons 4 days after nerve lesion. However, this value rises to 35% in the chronically decentralized pelvic ganglion. Therefore, recovery of an enkephalin plexus occurs irrespective of whether the pelvic nerve, or both the hypogastric and pelvic nerve have been cut. Although these findings suggest sprouting within partially decentralized ganglia, the similar incidence of an ENK plexus in ganglia subjected to chronic partial or total decentralization indicates that preganglionic fibers are not responsible for the emergent fibers.

Animals↗
PubMed1995

Geographically-decentralized planning and management in health care: some informational issues and their implications for efficiency.

Geographically decentralized planning and management is an emerging theme within the health sector in many OECD countries. Advocates of decentralization argue that providing greater authority to local decision-making bodies can improve both the technical and allocative efficiency with which health care systems operate. Using concepts drawn from organizational theory and the economics of organizations, we examine the potential of centralized and decentralized planning and management structures to be efficient in light of the informational problems that must be overcome to allocate resources efficiently. We focus in particular on the need to integrate information regarding: (1) the effectiveness and efficiency of alternative clinical interventions and of alternative ways organize the delivery of health care; (2) the needs, values, and preferences in the population; and (3) local circumstances that affect delivery of care across regions. Informational concerns suggest that decentralized structures have greater potential to be efficient. We then briefly discuss some principles for the design of decentralized structures to aid in realizing these potential efficiency gains.

Decision Making, Organizational↗
PubMed2001

Phototherapeutic keratectomy for decentration and central islands after photorefractive keratectomy.

PURPOSE: To determine visual outcomes after treatment of decentration and central islands occurring after photorefractive keratectomy (PRK). DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Patients (n = 14) who exhibited decentration or central islands after PRK and photoastigmatic keratectomy (PARK). METHODS: Fourteen eyes with post-PRK decentration (group I) or central islands (group II) were treated by transepithelial phototherapeutic keratectomy guided by epithelial fluorescence without modulating agents, and subsequently were treated with PRK or PARK. Mean follow-up time was 9 months (range, 45 days-21 months). MAIN OUTCOME MEASURES: We analyzed pre- and postoperative keratometry, refractive errors, uncorrected visual acuity (UCVA), best-corrected visual acuity, and haze. In group I, we also measured pre- and postoperative decentration; in group II, we compared pre- and postoperative central island power. RESULTS: Group I showed improvement in centration (P = 0.003). Group II showed decreased central island power (P = 0.18). -LogMAR UCVA improved from 0.59 (20/80(+1)) to 0.17 (20/30) (P = 0.03) and from 0.74 (20/100(-1)) to 0.21 (20/30(-1)) (P = 0.01) after retreatment of groups I and II, respectively. CONCLUSIONS: Retreatment of patients having decentration and central islands after PRK results in improved visual outcomes.

Adult↗
PubMed1993

Decentration associated with asymmetric capsular shrinkage and intraocular lens size.

An intraocular lens (IOL) may become displaced even when it has been implanted in the capsular bag. Asymmetric capsular shrinkage is one cause of lens decentration. To determine whether the IOL length influences the degree of decentration, we assessed the decentration of IOLs of different lengths in rabbits. After a D-shaped anterior capsulotomy that covered about half the area of an ordinary circular capsulotomy was performed in 19 eyes of ten white rabbits, a 14.0 mm IOL was fixated in the bag in one eye and a 12.5 mm IOL in the other eye. A circular anterior capsulotomy was performed in 16 eyes of eight controls and IOLs were similarly placed in the bag. Decentration of the 14.0 mm and 12.5 mm IOLs in the eyes with the D-shaped anterior capsulotomy did not differ eight weeks after the procedure. However, marked rotation from the initial position and decentration to the side opposite to that expected were observed in some eyes in which nodular opacification was observed. Both the 14.0 mm and 12.5 mm IOLs were markedly more displaced in eyes with the D-shaped anterior capsulotomy than in eyes with the circular anterior capsulotomy. These results confirm that asymmetric capsular shrinkage, which is affected by the anterior capsulotomy shape, influences post-operative IOL centration.

Animals↗
PubMed1995

Decentration associated with asymmetric capsular shrinkage and intraocular lens design in a rabbit model.

We evaluated intraocular lens (IOL) decentration resulting from asymmetric capsular shrinkage. In 19 eyes of 10 white rabbits, a D-shaped incision was made in the anterior capsule and one of three IOL types implanted in the capsular bag: three-piece with polypropylene haptics, one-piece all-poly-(methyl methacrylate) (PMMA), or compressible disk. Eight weeks later, eyes were enucleated for assessment of IOL decentration. Mean decentration was 0.75 mm for three-piece IOLs, 0.46 mm for one-piece IOLs, and 0.30 mm for compressible-disk lenses. Decentration was significantly less in eyes with compressible-disk lenses than in those with three-piece IOLs. Although decentration was less with the compressible-disk lens, the lens is not commonly used because of the large incision and special insertion technique required. If an open-loop IOL is to be used in eyes at risk for asymmetric capsular shrinkage, our results indicate that an all-PMMA one-piece IOL would be preferable to a three-piece lens with a polypropylene haptic.

Animals↗
PubMed1991

Decentration of intraocular lenses implanted after intercapsular cataract extraction (envelope technique).

Pseudophakos decentration produces symptoms such as glare, halos, and other visual aberrations. We have reviewed 161 eyes of patients who had an intercapsular cataract extraction with intraocular lens (IOL) implantation with a follow-up of at least six months. Mean decentration was 0.54 mm. It was 0.46 mm for the lenses implanted symmetrically in the bag, 0.65 mm for those implanted in the sulcus, and 0.91 mm for those implanted asymmetrically (bag-sulcus). The differences between the lenses fixated in the bag and those asymmetrically situated were statistically significant (P less than .001). Circular looped lenses (360-degree encircling loop) decentered less (mean 0.28 mm) than modified C-loop lenses (mean decentration 0.63 mm) and modified J-loop lenses (mean decentration 0.60 mm). These differences were statistically significant (P less than .001). The differences were also significant if we considered only the lenses implanted in the bag (mean decentration 0.20 versus 0.59 and 0.54, respectively) (P less than .0001).

Aged↗
PubMed1996

Postoperative decentration of three-piece silicone intraocular lenses.

PURPOSE: To compare the postoperative decentration of three-piece silicone intraocular lenses (IOLs) with polymide haptics and with polypropylene (PP) haptics and to determine whether the difference was caused by the haptic material. SETTING: Kimura Eye and Internal Medicine Hospital and Hitani Eye Clinic, Hiroshima, Japan. METHODS: Using a previously described photographic method, we calculated the postoperative decentration in randomly selected patients who had phacoemulsification and capsular bag implantation of three-piece silicone IOLs. In 64 patients, the IOL had polyimide haptics and in 57, PP haptics. One surgeon performed all the surgery using the same technique. RESULTS: Mean decentration of IOLs with polyimide haptics was 0.34 mm +/- 0.17 (SD) and of those with PP haptics, 0.48 +/- 0.30 mm. Although follow-up of the polyimide group was longer than that of the PP group (12.8 +/- 5.7 months and 8.7 +/- 4.0 months, respectively), decentration in the polyimide group was significantly smaller (P < .01). CONCLUSION: The lower rate of postoperative decentration in the IOLs with polyimide haptics was related to the haptic material.

Adult↗
PubMed1997

Decentration of 5.1 mm intraocular lenses after continuous curvilinear capsulorhexis and in-the-bag fixation.

PURPOSE: To determine the incidence of decentration in eyes with 5.1 mm optic intraocular lenses (IOLs) and to assess the effect on vision. SETTING: Clinical Cataract Research Unit, Oxford Eye Hospital, Oxford, England. METHODS: Patients having phacoemulsification and small IOL implantation over 12 months were identified and invited for assessment. Intraocular lens decentration was measured geometrically using a modified, digital, retroillumination camera. The expected incidence of symptoms caused by decentration was estimated by determining the presence of an IOL edge within an artificial pupil overlaid on the digital image. RESULTS: In 13 eyes (20%), IOL decentration was more than 0.5 mm. Symptoms were expected in 38 patients (59%) but occurred in only 14 (22%). CONCLUSION: Decentration of the 5.1 mm optic IOL caused fewer clinical problems than anticipated, although the results raise concerns that such IOLs may be inappropriate in patients who need excellent vision in scotopic illumination.

Aged↗