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PubMed2000

Hormonal and pharmacological manipulation of the circadian clock: recent developments and future strategies.

The mammalian circadian oscillator, located in the suprachiasmatic nuclei of the anterior hypothalamus, serves as the principal source of rhythmic temporal information for virtually all physiologic processes in the organism, including the alternating expression of sleep and wakefulness. Recent studies, in both animal models and human subjects, have demonstrated the important modulation of sleep and wakefulness mediated by the circadian clock. Independent of other factors, notably prior sleep-wake history, the circadian clock potentiates wakefulness (and alertness) at one phase of the diurnal cycle, while facilitating sleep and its attendant processes at the opposite phase. The adaptive advantage of synchronizing sleep-wake behaviors with the daily changes in the external environment is clear. But in a modern world where the constraints of environmental time are less and less important, the circadian clock still imposes rigid boundaries on the timing of sleep and alert wakefulness that are increasingly perceived as limitations on human performance. This conflict underlies the sleep "disorders" of jet lag and shiftwork sleep disruption, problems that are not really diseases at all, but instead reflect normal function of circadian timing in the context of extraordinary demands on sleep-wake scheduling. Whatever their proper classification, both jet lag and shiftwork insomnia represent important societal problems deserving of public health and medical attention. Barring a worldwide rejection of air-travel, jet lag will continue to afflict tens of thousands of people annually. The effects of jet lag on human performance, while typically transient, can nonetheless be significant, affecting commerce, government, and even the outcome of professional sports contests. More important, only a global regression to an agrarian economy will eliminate the problem of tens of millions of workers in this country who regularly attempt to work at night and sleep during the day. In contrast to jet lag, shiftwork produces chronic sleep disruption lasting for the duration of shiftwork exposure. For while individual differences in the ability to adjust to a nocturnal work schedule clearly exist, recent studies suggest that few if any night workers regularly experience restful and restorative day sleep equivalent to that considered normal at night. This chronic sleep limitation is associated with significant increases in a number of consequent problems including sleepiness-related accidents, social disruption, and psychiatric disturbances. In addition, chronic exposure to shiftwork has now been shown to be an independent risk factor for the development of both cardiovascular and gastrointestinal diseases. While these epidemiological studies have not identified the specific aspect of shiftwork that is associated with increased risk of these disorders, the chronic limitation and disruption is foremost among plausible factors. The most important aspect of human circadian physiology that limits adaptation to the extreme schedules inherent in shiftwork and jet travel is the primacy of light among entraining signals, or zeitgebers. Exposure to sunlight for night shiftworkers, or for jet travelers at their destination, results in maintenance (or resetting) of the clock to environmental time. This response can be prevented or overridden with extraordinary avoidance of sunlight or with provision of artificial light of sufficient duration and intensity to negate the sunlight signal, an approach shown to be effective in the treatment of shiftwork sleep disruption. Practical issues sharply limit the application of artificial lighting to all shiftwork settings, however, and the role for a pharmacological chronobiotic agent capable of accomplishing the same end is potentially very large (Copinschi et al., 1995; Jamieson et al., 1998). For example, the effects of zolpidem vs. placebo on sleep, daytime alertness, and fatigue in travelers who complain of jet lag was co

Antidepressive Agents, Tricyclic↗

PubMed1999

Some emerging food and water borne pathogens.

Emerging pathogens are those infective organisms whose incidence has recently increased or is likely to increase during the next two decades due to changes in demography, food habits, food technology, commerce, water sources and environmental factors. Some important emerging food and water borne bacterial pathogens include Listeria monocytogenes, Campylobacter jejuni, Yersinia enterocolitica, Salmonella enteritidis, Escherichia coli O157: H7, Vibrio cholerae biotype E1 Tor Serotype 0139, Vibrio parahaemolyticus and Aeromonas hydrophila, A. sobria, and A. caviae. The prevalence, ecological relationships of these organisms, their transmission through food, water and other environmental sources, and role of their virulent factors in the pathogenesis of infections and their public health significance is discussed in this paper with special reference to the situation in India.

Animals↗

PubMed2000

HIPAA brings new requirements, new opportunities.

The passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) brought with it the need for Federal rules to implement the act's simplification and cost-reduction efforts. HHS has published proposed rules related to security for the electronic transmission of health information, privacy of individually identifiable health information, transactions and code sets, and national provider and employer identifiers. Additional proposed rules will be published this year for claims attachments and health plan identifiers. Although HIPAA does not require providers to conduct business electronically, the new standards give providers the opportunity to reduce healthcare administrative costs significantly and undertake electronic commerce efficiently and cost-effectively.

Computer Security↗

PubMed2000

Regression method to estimate provisional TLV/WEEL-equivalents for non-carcinogens.

There is a huge and changing number of chemicals in commerce for which workplace exposure criteria have not been assigned. Assigning an exposure criterion by an expert committee is resource-intensive-not soon available for the large majority of chemicals in current use. In the absence of assigned criteria, we have provided a regression method to estimate a first-screen estimate of a 'TLV/WEEL-equivalent' inhalation time-weighted average exposure criterion for a pure chemical (or chemical group) from a measure of a non-stochastic toxic exposure to elicit a chronic or sub-chronic health effect, known as a lowest observable adverse effect level (LOAEL) or a (highest) no observable adverse effect level (NOAEL). Results are presented for six data sets for which both a threshold limit value (TLV) or workplace environmental exposure level (WEEL) exposure criterion is presently assigned, and a LOAEL or NOAEL measure of toxic health effect was available from the United States Environmental Protection Agency Integrated Risk Information System data base. The results can be applied as a first estimate of exposure to substances for which no TLV or WEEL (TLV/WEEL) exists, and also serve as a mechanism for identifying substances for potential re-evaluation of their exposure limit, based on their relative position about the prediction models.

Air Pollutants, Occupational↗

PubMedDate not supplied

Using the Internet for research.

OBJECTIVE: (1) To give an overview of research tools, techniques, and resources that are available on the Internet; and (2) to identify valid, pharmacy-related information that will reduce uncertainty in the problem-solving activities of practitioners. DATA SOURCES: The World Wide Web. STUDY SELECTION: Examples cited in the article were evaluated according to the criteria offered in the text as a prerequisite for their inclusion. DATA SYNTHESIS: Functional aspects of the Internet include communication, commerce, and content. Because a lack of control has led to mixed information quality, the use of Internet-based information for patient care and professional decision making should be subject to rigorous screening criteria. Pharmacists can use Web browsers combined with excellent search engines and search techniques to identify quality resources, including primary, secondary, and tertiary literature, either fee-based or free, and that can be sought actively or distributed on a schedule directly to the desktop of the pharmacist. CONCLUSION: The Internet can be an immensely helpful research tool, if used appropriately. Whether actively searching or passively receiving useful updates, the Internet can function as a value-added asset to any pharmacy practice.

Humans↗

PubMed2000

Linking Internet strategy to high-quality, cost-effective managed care.

This article describes an experimental pilot project incorporating e-commerce and the Internet into the traditional process of health benefit negotiations through the utilization of an HMO Internet auction. The timeline and process of the auction are described, with the final auction taking place during the last week of negotiations. The results reveal an efficient and effective system to augment the traditional benefit negotiation process.

Cost-Benefit Analysis↗

PubMedDate not supplied

[Hospital function and the urban system in Brazil].

Do hospital services, like other services and commerce, contribute to the structuring of geographical regions, as proposed by central place theory? This question raises the issue of the rating of hospital facilities in land use planning policies. According to the theory, a polarized region forms around a central place due to the minimization of transport costs by consumers seeking to satisfy their needs. If a center offers more central functions (rare trades, services for individuals and businesses), its level in the urban hierarchy is raised and its area of influence expands. This theory was validated using a model, the variant of the gravitation model proposed by Huff. Brazil is an excellent testing ground for these hypotheses due to the great variety of geographic situations, economic and social development levels and the availability of sufficient data. Geographic research has resulted in the construction of an urban center hierarchy based on central functions, and the Unified Health System (or SUS) systematically records authorizations for hospital admission (or AIH) throughout the country. Processing of the 12 million AIH for 1996 showed that in a quarter of cases, the individual was admitted to hospital in a town other than their town of residence (exogenous AIH). Mapping the percentage of exogenous AIH makes it possible to delimit the area of influence of health services (observed influence) for the whole of Brazil. In Minas Gerais State, these areas of influence were compared with the estimates made according to the Huff model (calculated influence), with adjustment for distance and the number of hospital beds. Differences between the observed and calculated areas of influence are due to factors not taken into account by the model, such as the heterogeneity of many regions in the country. However, the accuracy of the estimation is satisfying, as is the simplicity of the equations. All the results tend towards a single conclusion: hospital services play a major role in the structuring of geographic space, by increasing the attraction potential of urban centers.

Brazil↗

PubMed2000

A new pathway to product standardization.

As the benefits of product standardization become more evident in improved financial, managerial, and clinical outcomes, tools to make the process easier will be in demand. Once a standardization program is established, e-commerce offers tools to keep it on track.

Documentation↗

PubMed2000

The complexities of HIPAA and administration simplification.

BACKGROUND: The Health Insurance Portability and Accessibility Act (HIPAA) was signed into law in 1996. Although focused on information technology issues, HIPAA will ultimately impact day-to-day operations at multiple levels within any clinical setting. Optometrists must begin to familiarize themselves with HIPAA in order to prepare themselves to practice in a technology-enriched environment. METHOD: Title II of HIPAA, entitled "Administration Simplification," is intended to reduce the costs and administrative burden of healthcare by standardizing the electronic transmission of administrative and financial transactions. The Department of Health and Human Services is expected to publish the final rules and regulations that will govern HIPAA's implementation this year. RESULTS: The rules and regulations will cover three key aspects of healthcare delivery: electronic data interchange (EDI), security and privacy. EDI will standardize the format for healthcare transactions. Health plans must accept and respond to all transactions in the EDI format. Security refers to policies and procedures that protect the accuracy and integrity of information and limit access. Privacy focuses on how the information is used and disclosure of identifiable health information. Security and privacy regulations apply to all information that is maintained and transmitted in a digital format and require administrative, physical, and technical safeguards. CONCLUSIONS: HIPAA will force the healthcare industry to adopt an e-commerce paradigm and provide opportunities to improve patient care processes. Optometrists should take advantage of the opportunity to develop more efficient and profitable practices.

Health Insurance Portability and Accountability Ac↗

PubMed2000

Benefits and problems with cloning animals.

Animal cloning is becoming a useful technique for producing transgenic farm animals and is likely to be used to produce clones from valuable adults. Other applications will also undoubtedly be discovered in the near future, such as for preserving endangered breeds and species. Although cloning promises great advantages for commerce and research alike, its outcome is not always certain due to high pregnancy losses and high morbidity and mortality during the neonatal period. Research into the mechanisms involved in the reprogramming of the nucleus is being conducted throughout the world in an attempt to better understand the molecular and cellular mechanisms involved in correcting these problems. Although the cause of these anomalies remains mostly unknown, similar phenotypes have been observed in calves derived through in vitro fertilization, suggesting that culture conditions are involved in these phenomena. In the meantime, veterinarians and theriogenologists have an important role to play in improving the efficiency of cloning by finding treatments to assure normal gestation to term and to develop preventative and curative care for cloned neonates.

Animal Husbandry↗

PubMed2000

Digital health care: where health care, information technology, and the Internet converge.

The digital health care industry applies information technologies to facilitate communications, commerce, transactions, business problem solving, and enhanced decision making for one or more groups that supply, consume, or finance health care services and products. The variation among companies is significant, but each one attempts to leverage information technology to drive sustainable evolutionary change. In an overview of the industry, a framework is provided to understand the maze of business plans.

Computer Security↗

PubMedDate not supplied

Too old to learn?

C.J. Albert, the head of family-owned Armor Coat Insurance, is just settling in on a Sunday evening when the receives an unsettling phone call from his star salesman. Fifty-two-year-old Ed McGlynn has just returned from a business dinner with his younger technology mentor, and he's none too happy with the way he's being treated. If C.J. doesn't take this attack dog off him, Ed warns, he's gone. C.J. had indeed assigned 28-year-old Roger Sterling--the company's monomaniacal, slightly antisocial director of e-commerce--to teach Ed about digital strategy and the Web. Reverse mentoring seemed like a good way to create synergy between the sales and technology groups. The goal was to create a digital insurance product that would allow Armor Coat to keep up with its competitors. But there'd been tension between Ed and Roger right from the start--stemming from their personalities and their two departments. So when the two reluctantly agreed to meet for dinner to talk, the conversation didn't go well. Ed insisted that great sales reps, not the Internet, are crucial to selling insurance. Roger insisted that the Web will revolutionize the way insurance is sold and distributed--that Ed either give in or move on. Ed took off in a huff and subsequently phoned C.J. Roger followed Ed's irate call with his own weary ultimatum: "Either Ed goes or I go." C.J. faces some difficult Monday-morning discussions with both disgruntled parties. What should he do? Six commentators, including a mentor-protégé pair, offer their advice in this fictional case study.

Administrative Personnel↗

PubMed2000

Supply-chain management: exceeding the customer's expectations.

Driven by increasing competition, manufacturers are desperate to cut costs and are looking for increased efficiency and customer service from their supply chains. E-commerce offers a new model of supply and demand, but many companies do not have the processes in place to support this new model. By implementing the techniques discussed here they can achieve substantial improvements in performance.

Consumer Behavior↗

PubMed2000

John E. Echternacht: practitioner and community leader.

For Minnesota dentists with long memories, Dr Jack Echternacht is a legendary figure. He graduated from the University of Minnesota School of Dentistry in 1943. Except for a 3-year enlistment in the Navy during World War II, he has made his home and his professional life in Brainerd, on the edge of Minnesota's lake country. A few years after he started his general practice, reports began to appear about the striking reduction of dental caries in children's teeth when fluoride was placed in the drinking water. Excited by these prospects for better oral health, Dr Echternacht led a Chamber of Commerce initiative in 1954 to introduce fluoride into Brainerd's water supply. What seemed at first an easy victory turned into a 30-year struggle. Dr Echternacht's determination, persistence, and leadership during this fight for fluoridation led to his selection as a moral model in dentistry.

Dental Caries↗

PubMed2001

Preventing and controlling tuberculosis along the U.S.-Mexico border.

Converging factors contribute to elevated tuberculosis (TB) incidence and complicate case management in the U.S. states bordering Mexico. These factors include a) Mexico's higher TB rate; b) low socioeconomic status and limited access to health care in the border area; c) frequent border crossings and travel in the United States for employment, commerce, health services, and leisure; d) language and sociocultural differences; and e) lack of coordinated care across health jurisdictions on both sides of the U.S.-Mexico border. Prevention and control efforts that address the challenges created by border-crossing populations require collaboration among local, state, and national TB control programs in both countries. In June 1999, to facilitate future discussions with Mexican counterparts, CDC convened a meeting of TB control officials from the four U.S. states bordering Mexico (i.e., California, Arizona, New Mexico, and Texas) to address TB prevention and control in the border area. Focus areas included a) surveillance needs, b) case management and therapy completion, c) performance indicators and program evaluation, and d) research needs. Meeting participants' deliberations and resulting proposals for action by CDC and state and local TB control programs are detailed in this report.

Antitubercular Agents↗

PubMed2001

Employee theft and fraud: bigger than ever and getting worse.

Fraud examiners and investigators say that employee theft is out of control, citing recent U.S. Chamber of Commerce figures that employees steal approximately $400 billion from businesses each year and an Ernst & Young survey showing that nearly 90% of organizations countrywide experienced some type of fraud in the 12 months prior to the survey. An additional undetermined amount is being reported lost because of external fraud committed by customers, vendors, and others having contact with a company or institution. Fraud experts interviewed for this report note that all sectors are targets--including retailers, hospitals and healthcare, the hotel industry, schools, and college campuses. In this report, we'll present the how's and whys of this development and also describe what one medical center is doing to stop thefts of medical equipment and computers.

Fraud↗

PubMed1975

Food and Drug Administration regulations and licensure.

The regulatory requirements of the Food and Drug Administration for products that are defined as drugs and/or biologics are extensively documented in the applicable sections of the Code of Federal Regulations. They include broad requirements for good manufacturing practices and a number of general requirements for matters such as sterility, stability, pyrogens, and labeling. In addition, for biological products, specific standards are published for comment in the Federal Register and then as final rules prior to the acceptance of license applications for new products. The major criteria for such products are safety and effectiveness when the products are used prudently as directed in accompanying circulars. It is generally sound practice to obtain extensive toxicologic and pharmacologic knowledge of potential new products prior to embarking on clinical trials. These trials must be described in investigational new drug applications (INDs), if the products will be entered into interstate commerce. Clinical trials should be planned and conducted using sound scientific and ethical principles in order to obtain objective evidence of clinical effectiveness without unduly jeopardizing the participants in such studies.

Biological Products↗

PubMedDate not supplied

MedDigital trends and tactics to lead into the future.

Physician executives need to harness appropriate digital technology by understanding key trends and implementing best tactics. Being and doing MedDigital means taking back control and improving care--and, at the same time, improving efficiencies and the bottom line. This article presents seven e-trends that are shaping health care: (1) Consumers and patients are pushing doctors to go digital; (2) from Web health information to MedDigital decision support; (3) beyond managed care to custom health; (4) wireless is the way of the new world; (5) Passive web portals yield to digital destinations; (6) e-commerce means lower transaction cost; and (7) develop e-health care ROI methodologies and track results. The authors provide myriad examples of new technology that will revolutionize health care and provide both physicians and consumers with valuable interactive tools to enhance health, treatment, and decision-making.

Ambulatory Care Information Systems↗