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PubMed1997

1996 Andrew Pattullo lecture. A vision of the role of health administration education in the transformation of the American health system.

In summary, it is my conviction that each of the AUPHA programs would be well advised to re-discover a shared vision of health care as public service, caring for communities as well as for patients and enrolled populations. I am also convinced that each program should be shaping a shared vision of the role of the academic program in providing intellectual leadership in this respect. These processes can be designed to have impact on all of the activities of the program, starting with low hanging fruit, and moving higher with growing confidence and commitment. The key task for AUPHA as an organization right now is ro re-examine its own vision as a basis for providing strong leadership to the field. This involves promoting visioning as a management tool, helping to sharpen the accreditation requirements in this respect, and carrying out the recommendation of the Pew Health Professions Commission to bring the academic and practitioner worlds into closer synch. The talent and the zeal are evident. What is required now is the will to make changes. Continued transformation of the American Health system and of the academic programs in health administration are both inevitable. Managing the transformation is more exciting, more productive, more professionally satisfying and more fun than just surviving or not surviving at all. Managing a transformation is not easy, especially in academia. Just watching it happen is not nearly as satisfying or as much fun.

Consumer Advocacy↗
PubMed2002

Vision and mobility performance of subjects with age-related macular degeneration.

PURPOSE: To investigate the effects of age-related macular degeneration (ARMD) on mobility performance and to identify the vision determinants of mobility in subjects with ARMD. METHODS: Walking speed and the number of obstacle contacts made on a 79-m indoor mobility course were measured in 21 subjects with ARMD and 11 age-matched subjects with normal vision. The mobility measures were transformed to percentage preferred walking speed and contacts score. The vision functions assessed included binocular visual acuity, contrast sensitivity, and visual field. RESULTS: In this study, subjects with ARMD did not walk significantly slower or make significantly more obstacle contacts on the mobility course than the normally sighted subjects of similar age. Between 29% and 35% of the variance in the ARMD mobility performance was accounted for by visual field and contrast sensitivity measures. The most significant predictor of mobility performance scored as percentage preferred walking speed was the size of a binocular central scotoma. CONCLUSION: As the size of a binocular central scotoma increases, mobility performance decreases.

Aged↗
PubMed2005

The effect of visual transformation on bimanual circling movement.

In order to examine the effect of visual transformation on bimanual movements of various difficulty, fourteen participants performed bimanual circling tasks in three asymmetric movement modes--90 degrees (the left hand precedes the right hand by 1/4 cycle), 180 degrees (the delay between two hands is 1/2 cycle), and 270 degrees (the left hand precedes the right hand by 3/4 cycle)--under the normal vision condition and the visual transformation condition. In the visual transformation condition, movement of the right hand was transformed so that the required bimanual movement was always presented visually as a symmetric pattern. Additionally, the participants also performed a 0 degrees mode (in-phase symmetric) movement. Results revealed that the visual transformation increased the movement accuracy, with the variability of the right-left difference unchanged. Thus, proper visual transformation can improve the accuracy of a movement task. The 0 degrees mode was performed with higher stability and accuracy than any other movement modes of the visual transformation condition and normal vision conditions. In addition, the constant error associated with the 90 degrees and 270 degrees modes indicated that, in the normal vision condition, the executed movement was shifted to the 180 degrees mode, whereas in the visual transformation condition it stayed around the required mode and was slightly shifted to the 0 degrees mode. This result suggests that visual transformation can change the relationship between the intention to realize the required mode and the intrinsic neuromuscular dynamics. The effect size of visual transformation was larger in the 90 degrees and 270 degrees modes than in the 180 degrees mode. It is thus concluded that the effect of visual transformation depends upon the difficulty of the movement task.

Adult↗
PubMed1988

Assessing the performance of information technology.

Most hospital executives have difficulty assessing the impact of information technology (IT) and the performance of IT personnel. This article describes three management visions for IT--automate, informat and transform--and seven assessment procedure for determining which vision may be most relevant to a specific hospital.

Efficiency↗
PubMedDate not supplied

Managing change isn't good enough.

One lesson learned from past reengineering is that to be successful in the next decade, organizations will need to create and lead transformation, not just manage the process. Two critical aspects of transformation are that it is a process and that it requires leadership. The "five Cs" of transformation are imperative: create the vision, create the plan, communicate the vision and the plan, cultivate motivated and empowered stakeholders, and cement change in the organization's culture. Business skills, the ability to lead others, and the ability to forge and maintain relationships are needed for effective leadership. For successful transformation, businesses must avoid the mistakes made in the past decade, including too much complacency, too little and/or inappropriate communication, and underestimating the importance of vision and leadership to the transformation effort.

Communication↗
PubMed2000

Transformation of the visual-line value in binocular vision: stimuli on corresponding points can be seen in two different directions.

We examined Wheatstone's (1838 Philosophical Transactions of the Royal Society of London 128 371-394) claim that images falling on retinally corresponding points can be seen in two different directions, in violation of Hering's law of identical visual direction. Our analyses showed that random-dot stereograms contain stimulus elements that are conceptually equivalent to the line stimuli in the stereogram from which Wheatstone made his claim. Our experiment demonstrated that two lines embedded in a random-dot stereogram appeared in two different directions when they stimulated retinally corresponding points, if the disparity gradient value of the lines was infinity relative to adjacent elements. To ensure that the two lines stimulated corresponding points, observers made vergence eye movements while maintaining the perception of the two lines in two different directions.

Convergence, Ocular↗
PubMed1990

Molecular analysis of no-on-transient A, a gene required for normal vision in Drosophila.

Mutation of the Drosophila melanogaster gene no-on-transient A (nonA) results in reduced visual acuity, behavior abnormalities, and an electrophysiological defect for which the mutant is named. We mapped the nonA gene genetically to a 20 kb interval within the 14C1,2 region of the X chromosome, isolated this chromosomal region, and used P element-mediated transformation to delimit the nonA gene to a 9 kb region. Analysis of cDNA clones indicates that this region encodes alternatively spliced transcripts encoding protein products of approximately 77 kd that differ only in their C-terminal 35 amino acids. Analysis of mutations generated in vitro in this transcription unit confirm that these transcripts are the products of the nonA gene.

Amino Acid Sequence↗
PubMed2006

Long-lasting aftereffect of a single prism adaptation: shifts in vision and proprioception are independent.

After a single adaptation session to prisms with gradually incremented shift magnitude, the prism adaptation aftereffect was measured by open loop mid-sagittal pointing (O) to a visual target without visual feedback. This aftereffect corresponded to the summation of the shift in proprioception, measured by straight ahead pointing without vision (S), and the visual straight ahead judgement (V), measured by verbal stopping of an LED moving from two opposite directions. However, the measurement of the aftereffects made over a period of 7 days revealed significantly different decay curves in V, O and S. Surprisingly the S shift was still present up to 7 days after the training, while V had returned to the original level by 2 h, which was the first measurement after subjects returned to a normal visual environment. O had returned to pre-test level after 1 day. After 3 days Wilkinson's (J Exp Psychol 89:250-257, 1971) additive hypothesis (O=S-V) no longer fit the data. Rather "O=Pl-V", where Pl (Pr) is the shift in proprioception measured by passive lateral arm movements from left (right), fitted better during the whole 7 days of aftereffect in our study. Therefore, the aftereffect of our strong prism adaptation revealed, firstly, that classical open loop pointing consisted of aftereffect shifts equal to the summation of the shifts in the two passively measurable aftereffect components, vision (V) and proprioception (Pl), rather than with active straight ahead pointing (S). Secondly, the decay of the shift in visual perception and in passively measurable proprioception is independent. The former decays fast, and the latter decays slowly with two separate waves. Thirdly, we suggest that the use of visual perception-dependent spatial codes for visual-manual transformation and the vision-independent internal egocentric reference frame are mutually exclusive. We proposed a model to explain these possible mechanisms.

Adaptation, Physiological↗
PubMed1990

The independence of horizontal and vertical dimensions in handwriting with and without vision.

The purpose of this study was to investigate the relationship between horizontal and vertical components of handwriting production when subjects were instructed to vary the size of these components separately or together. The effect of vision on these instructed size transformations also was examined. Eight female adults participated in the experiment. The basic task was to write the words 'poppy' and 'wood' cursively five times, the first time in their normal size and then with four size transformations. These transformations--one-fourth, one-half, double, and four-times their normal size--were made under three different sets of instructions (width only, height only, both) and in two visual conditions (normal, blindfolded), for a total of six sets of five repetitions. The individual slopes (changes in actual values across the transformation values) for width and height under instructions to change both parameters were almost identical to the width and height slopes under instructions to change only the single parameter, supporting the notion of the independence of the horizontal and vertical components. Further, an analysis of these individual slopes indicated that the size transformations were significantly greater (p less than 0.05) (and closer to the instructed values) with vision than without vision.

Adult↗
PubMedDate not supplied

The transformational leadership of critical care nurse-managers.

This study of transformational leadership found critical care nurse-managers to be highly transformational, using inspiration, motivation, and vision to empower staff, rather than intervening only when problems arise. Significant positive relationships were found between transformational leadership and previous leadership experience. The findings have implications for the recruitment, selection, and development of nursing leaders.

Adult↗
PubMed2002

The painter and handicapped vision.

A realist painter seeks to transform a three-dimensional stereoscopic image on to a two-dimensional surface, utilising one or more of the familiar cues to distance including linear and aerial perspective, relative size, overlap, tonal variation and use of colour. Sometimes this process can be jeopardised by one or more commonly occurring inherited and acquired vision problems, in particular errors of refraction, cataract, maculopathies, lack of binocularity and colour vision defects. Historically, several painters have been alleged to have suffered from one or more of these disorders to account for their particular style or changes in technique. The effects of these anomalies are discussed in relation to painters with particular emphasis on the ability for adaptation to occur.

Adaptation, Physiological↗
PubMed1979

Ocular complications following blast transformation in chronic myelogenous leukemia.

A number of ocular problems compromising vision occurred in a patient with chronic myeloid leukemia following blastic transformation. Hemorrhagic retinopathy developed with systemic relapse and resolved with control of systemic disease. Optic nerve involvement occurred with meningeal leukemia and was controlled with intrathecal cytosine arabinoside and methotrexate. Leukemic retinal infiltrates developed despite control of systemic and meningeal disease and were successfully treated with radiation therapy. Finally, bilateral vitreous hemorrhages occurred, severely impairing vision. Leukemic infiltration of the eye may occur with increasing frequency in CML as the survival following bastic transformation improves. Infiltration should be recognized and treated promptly if serious loss of vision is to be avoided. Central nervous system prophylaxis should be considered in patients achieving a complete response following therapy for transformation.

Adult↗
PubMed2004

Systems-based framework for continuing medical education and improvements in translating new knowledge into physicians' practices.

Concerns about health care costs and quality are focusing increasing attention on physicians and their continuing medical education (CME). These concerns have produced several calls for "a new definition, " "a new vision, " "repositioning, " "reinventing, " and "transforming" CME. However, differences in conceptualizations and vocabularies have introduced appreciable confusion in recommending changes. This article uses a systems-based approach to describe and analyze the processes involved in translating new information into physicians' practices. The article (1) introduces a conceptual framework that links physician learning and performance to systems for information, education, implementation, and regulation in the context of the larger health care system; (2) uses the framework to identify concerns and opportunities for the major types of systems immediately relevant to CME; and (3) uses the framework to suggest broader implications for CME, including the nature of process for changing physicians' practices, needed improvements, priorities in performing research, and implications for CME professionals.

Diffusion of Innovation↗
PubMed2001

The nonA gene in Drosophila conveys species-specific behavioral characteristics.

The molecular basis of species-specific differences in courtship behavior, a critical factor in preserving species boundaries, is poorly understood. Genetic analysis of all but the most closely related species is usually impossible, given the inviability of hybrids. We have therefore applied interspecific transformation of a single candidate behavioral locus, no-on-transient A (nonA), between Drosophila virilis and D. melanogaster, to investigate whether nonA, like the period gene, might encode species-specific behavioral information. Mutations in nonA can disrupt both visual behavior and the courtship song in D. melanogaster. The lovesong of nonA(diss) mutant males superficially resembles that of D. virilis, a species that diverged from D. melanogaster 40-60 mya. Transformation of the cloned D. virilis nonA gene into D. melanogaster hosts carrying a synthetic deletion of the nonA locus restored normal visual function (the phenotype most sensitive to nonA mutation). However, the courtship song of transformant males showed several features characteristic of the corresponding D. virilis signal, indicating that nonA can act as a reservoir for species-specific information. This candidate gene approach, together with interspecific transformation, can therefore provide a direct avenue to explore potential speciation genes in genetically and molecularly tractable organisms such as Drosophila.

Animals↗
PubMedDate not supplied

Pharmacist care plans and documentation of follow-up before the Iowa Pharmaceutical Case Management program.

OBJECTIVES: To document drug therapy problems and their causes and assess pharmacist follow-up of patients with identified drug therapy problems. DESIGN: Cross-sectional analysis. SETTING: Iowa. PARTICIPANTS: 160 pharmacists who submitted 754 pharmaceutical care plans in an effort to qualify for participation in the Iowa Pharmaceutical Case Management program. INTERVENTIONS AND MAIN OUTCOME MEASURES: Care plans were assessed for drug therapy problems and causes and for documentation of pharmacist follow-up (actual, none, or intent to follow up). RESULTS: Pharmacists documented a wide variety of drug therapy problems and causes, including adverse drug reactions (20.1% of care plans), need for additional drug therapy (18.9%), lack of patient adherence to therapy (16.3%), incorrect medication being prescribed (14.1%), and drug dose too high (10.0%). Pharmacist follow-up with patients was not optimal, with 31% of care plans providing documentation of actual follow-up. Another 42.2% of plans indicated that the pharmacist intended to contact the patient for follow-up but either did not do so or did not record the intervention. No actual follow-up or intent to follow up was recorded in 26.8% of care plans. Pharmacists practicing in independent pharmacies followed up with patients more frequently than those in other settings (36.4% of care plans, compared with 22.7%, 23.2%, and 28.4% for chain, clinic, and franchise pharmacies). Pharmacists were more likely to follow up when the identified problem involved drug safety rather than effectiveness (36.2% versus 28.3% of care plans). CONCLUSION: Documentation of pharmacist follow-up with patients was less than optimal. In addition to identifying drug therapy problems and causes, pharmacists must complete the care continuum through documentation of patient monitoring and follow-up to transform the philosophy and vision of the pharmaceutical care concept into a practice of pharmacy recognized and rewarded by patients and payers.

Case Management↗
PubMed2001

Surveying the seen: 100 years of British vision.

Perceptual phenomena and their interpretations have fashioned the course of psychology. This article surveys how theories of visual perception and methodologies have developed during the lifetime of the British Psychological Society. The experimental study of vision was instigated by British natural philosophers in the early nineteenth century but this impetus was not maintained thereafter. Not until the 1930s and 1940s did research on perception resume in earnest within British universities. The adoption of concepts (such as schema) potentially grounded in neural organization, particularly by Bartlett and Craik, accelerated experimental, theoretical and applied vision research. From mid-century the influence of information processing models of perception became increasingly dominant, and they were often integrated with the rapidly expanding understanding of neurophysiological underpinnings. The epitome of these developments was Marr's model of vision which, in our view, marked the start of the modern era of vision research. Computers have transformed the nature of stimulus control and response measurement in perceptual experiments. More naturalistic stimuli can be presented and manipulated, and complex behavioural responses, such as patterns of eye movements, fractionated. Non-invasive recording of brain activity to visual stimulation has similarly been transformed with a variety of methods for imaging brain activity. Neuroimaging has been applied to localizing perceptual and cognitive functions and in studying patients with known deficits in visual recognition. However, the eagerness with which the computer has been adopted by perceptual psychologists is likely to be tempered by a growing awareness of the differences between viewing scenes and simulations of them.

Brain↗
PubMed2001

Surveying the seen: 100 years of British vision.

Perceptual phenomena and their interpretations have fashioned the course of psychology. This article surveys how theories of visual perception and methodologies have developed during the lifetime of the British Psychological Society. The experimental study of vision was instigated by British natural philosophers in the early nineteenth century but this impetus was not maintained thereafter. Not until the 1930s and 1940s did research on perception resume in earnest within British universities. The adoption of concepts (such as schema) potentially grounded in neural organization, particularly by Bartlett and Craik, accelerated experimental, theoretical and applied vision research. From mid-century the influence of information processing models of perception became increasingly dominant, and they were often integrated with the rapidly expanding understanding of neurophysiological underpinnings. The epitome of these developments was Marr's model of vision which, in our view, marked the start of the modern era of vision research. Computers have transformed the nature of stimulus control and response measurement in perceptual experiments. More naturalistic stimuli can be presented and manipulated, and complex behavioural responses, such as patterns of eye movements, fractionated. Non-invasive recording of brain activity to visual stimulation has similarly been transformed with a variety of methods for imaging brain activity. Neuroimaging has been applied to localizing perceptual and cognitive functions and in studying patients with known deficits in visual recognition. However, the eagerness with which the computer has been adopted by perceptual psychologists is likely to be tempered by a growing awareness of the differences between viewing scenes and simulations of them.

Journal Article↗
PubMedDate not supplied

Patient-focused care: what managers should know.

Implementation of PFC is considered a "rational" strategic choice in that it is thought to decrease the cost of providing health care while increasing the quality of services. Published research and evaluation studies that describe PFC are analyzed and the information is synthesized in hopes of discovering and describing commonalties among definitions, goals, and principles underlying PFC. The commonly accepted description of PFC is a model which "seeks to integrate the organization's values and culture with the operational excellence vision and processes to transform the institution into a customer-focused organization." Staff satisfaction is addressed by encouraging staff to plan and execute their clinical work in ways that are most responsive to patient needs. Grouping similar patients, bringing services closer to these patients, and appropriate cross-training of multidisciplinary care providers to enhance continuity of care are seen as the four most common elements described in most of the literature.

Humans↗