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PubMed2000

Decentration and tilt: silicone multifocal versus acrylic soft intraocular lenses.

PURPOSE: To compare differences in decentration and tilt between a silicone multifocal and an acrylic intraocular lens (IOL) by evaluating postoperative changes. SETTING: Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea. METHODS: Forty eyes of 20 patients with IOL implantation were randomized into 2 groups according to IOL type: 3-piece silicone multifocal IOL or 3-piece acrylic IOL. All lenses were implanted in the capsular bag through a clear corneal incision after continuous curvilinear capsulorhexis and phacoemulsification. The amount of the decentration and the degree of the tilt of each IOL were measured using the EAS-1000 anterior eye segment analysis system 1 day and 1 and 2 months after surgery. RESULTS: No significant difference in decentration and tilt was found among the 3 follow-ups or between lens types. CONCLUSION: Neither IOL decentration nor tilt showed significant progression up to 2 months in eyes with a silicone multifocal or acrylic IOL when the IOLs were placed properly in the capsular bag. The amount of decentration and tilt was similar between lens types.

Acrylic Resins↗
PubMed2002

[Consequences of decentralization on the basis of a psychiatric department in the upper austrian salzkammergut].

OBJECTIVE: To describe the changes of utilization of a psychiatric department following its decentralization into an Upper Austrian region, the Salzkammergut. METHODS: 9 months before and after decentralization all kinds of contacts to psychiatric patients (inpatients, outpatients, day clinic patients, patients of consulting psychiatric service) regarding frequency of contacts, case numbers and diagnosis have been evaluated. For the inpatients their legal status was recorded. RESULTS: Since the establishment of the decentralized psychiatric department an increase in the frequency of admissions of inpatients up to 157 % could be revealed. Depressive disorders showed the largest increase of admissions (204 %), remarkable increase was also seen in substance use disorders, neurotic and organic disorders (between 171 % and 183 %). Changes also emerged concerning the legal status of the patients with a decrease of the percentage of involuntary admissions from 26.5 % prior to decentralization to 20.7 % thereafter. Among the patients seen by the consulting service length of stay was higher than usually seen on somatic wards as there was a very high proportion of patients with depressive syndromes. CONCLUSION: Within the context of decentralization provision of psychiatric care seems to be improved. Treating more patients with depressive and neurotic disorders the staff of the psychiatric ward was confronted to apply more psychotherapeutic interventions to meet the patient's neurotic and suicidal behaviour.

Austria↗
PubMed1990

Marked antiinflammatory effects of decentralization of the superior cervical ganglia.

Intravenous challenge with parasite antigens in Nippostrongylus brasiliensis-sensitized rats resulted in anaphylactic shock and, in some animals, death. Surviving animals showed significant drop in mean arterial blood pressure, cardiac output, and blood flow to the trachea, bronchioles, and mesentery. After anaphylaxis, changes in the cellular and protein composition in bronchoalveolar lavage fluids (BALF) were assessed. 8 h after antigen challenge, there was significant influx of inflammatory cells and an increase in the levels of histamine and serum-derived immunoglobulins (IgG and IgM) in BALF. Chemotactic activity for neutrophils was also present in BALF. Once we established this anaphylaxis-induced model of pulmonary inflammation, we sought to determine whether or not the superior cervical ganglia (SCG) modulate this inflammation. We performed bilateral superior cervical ganglionectomy or decentralization of the SCG. Our results show that decentralization significantly reduced mortality (by 68%) after anaphylaxis. Furthermore, the increases in levels of serum-derived proteins, histamine, and influx of cells (especially neutrophils) observed in BALF after anaphylaxis were attenuated by both decentralization and ganglionectomy. By contrast, hemodynamic parameters in the respiratory tract and the presence of neutrophil chemotactic activity in BALF were not influenced by decentralization. Thus, the severity of pulmonary inflammation initiated by systemic anaphylaxis is depressed by bilateral ganglionectomy or decentralization of SCG.

Animals↗
PubMed2002

Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space.

This study reviews the experience of decentralization in four developing countries: Ghana, Uganda, Zambia and the Philippines. It uses two analytical frameworks to describe and compare the types and degrees of decentralization in each country. The first framework specifies three types of decentralization: deconcentration, delegation and devolution. The second framework uses a principal agent approach and innovative maps of 'decision space' to define the range of choice for different functions that is transferred from the centre to the periphery of the system. The analysis finds a variety of different types and degrees of decentralization, with the Philippines demonstrating the widest range of choice over many functions that were devolved to local government units. The least choice was transferred through delegation to an autonomous health service in Ghana. Uganda and Zambia display variations between these extremes. There was insufficient evidence of the impact of decentralization to assess how these differences in 'decision space' influenced the performance of each health system. The authors suggest that this is a major area for future research.

Decision Making, Organizational↗
PubMed2003

Decentralization in Zambia: resource allocation and district performance.

Zambia implemented an ambitious process of health sector decentralization in the mid 1990s. This article presents an assessment of the degree of decentralization, called 'decision space', that was allowed to districts in Zambia, and an analysis of data on districts available at the national level to assess allocation choices made by local authorities and some indicators of the performance of the health systems under decentralization. The Zambian officials in health districts had a moderate range of choice over expenditures, user fees, contracting, targeting and governance. Their choices were quite limited over salaries and allowances and they did not have control over additional major sources of revenue, like local taxes. The study found that the formula for allocation of government funding which was based on population size and hospital beds resulted in relatively equal per capita expenditures among districts. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. General guidelines for the allocation of resources established a maximum and minimum percentage to be allocated to district offices, hospitals, health centres and communities. Districts tended to exceed the maximum for district offices, but the large urban districts and those without public district hospitals were not even reaching the minimum for hospital allocations. Wealthier and urban districts were more successful in raising revenue through user fees, although the proportion of total expenditures that came from user fees was low. An analysis of available indicators of performance, such as the utilization of health services, immunization coverage and family planning activities, found little variation during the period 1995-98 except for a decline in immunization coverage, which may have also been affected by changes in donor funding. These findings suggest that decentralization may not have had either a positive or negative impact on services.

Budgets↗
PubMed1993

Sensitivity of off-axis performance of aspheric spectacle lenses to tilt and decentration.

Apparatus was modified to measure, and theoretical raytracing was used to predict, off-axis powers of spectacle lenses in the presence of tilt or decentration. In response to poor fitting in the form of tilt or decentration, lenses with aspheric front surfaces were found to have greater off-axis power errors than best-form lenses with spherical surfaces. This is attributable to the aspheric lenses having flatter surfaces than the spherical lenses. The errors are up to twice those occurring for the spherical lenses, and can be quite high, e.g. 0.9 D astigmatism for +6D power with 10 degrees tilt in 20 degrees upgaze. Negative lenses are more sensitive to poor fitting than are positive lenses of the same power. The errors for straight ahead vision associated with tilt are approximately proportional to the square of the angle of tilt, and the errors for straight ahead vision associated with decentration are approximately proportional to the square of decentration. It is most important that aspheric lenses be correctly fitted, which means that each 2 degrees of pantascopic tilt should be accompanied by approximately 1 mm decentration.

Eyeglasses↗
PubMed2005

Impact of decentration of astigmatic intra-ocular lenses on the residual refraction after cataract surgery.

PURPOSE: The purpose of this study is to assess the impact of decentration of astigmatic intra-ocular lenses on the residual refraction after cataract surgery, using a computing scheme with 5 x 5 system matrices. METHODS: Based on the definition of an optical system in the paraxial Gaussian space containing astigmatic surfaces without restrictions to coaxiality, we derived a method (using 5 x 5 refraction and translation matrices) for calculating the residual refraction and the compensating prism in the spectacle plane after decentred implantation of thin and thick astigmatic intra-ocular lenses. The 'optical system eye' may contain astigmatic refractive surfaces with their axes at random. RESULTS: The capabilities of this computing scheme are demonstrated with two examples. In example 1 we calculate the residual refraction of a decentred 'thin astigmatic lens' for compensation of corneal astigmatism to achieve a spherical target refraction. In example 2 we compute the residual refraction after implantation of a 'thick astigmatic lens', where the spherical and cylindrical power as well as the implantation axis of the lens do not fully match the pre-operative recommendations and the lens is decentred relative to the optical axis. For both examples, we derive the residual prismatic effect in the spectacle plane and the lateral displacement of a ray exiting the spectacle correction when starting coaxially at the retina. CONCLUSIONS: We have presented an en bloc matrix-based strategy for the calculation of the residual spherocylindrical refraction at the spectacle plane after implantation of a decentred thin or thick astigmatic intra-ocular lens without restrictions to coaxiality. The resulting system matrix is written as a product of 5 x 5 refraction and translation matrices.

Astigmatism↗
PubMed1990

Evidence from lack of decentralization-induced supersensitivity that beta 2-adrenoceptors of the cat nictitating membrane are non-innervated.

The right superior of cervical sympathetic trunk of cats was sectioned preganglionically under anaesthesia. Six days later the blood pressure, heart rate and contractions of the left (control) and right (decentralized) nictitating membranes were recorded under chloralose anaesthesia (80 mg kg-1). The alpha-adrenoceptor-mediated contractile responses of the nictitating membrane to intravenous adrenaline were greater on the decentralized side than the control side, with a significant shift of the dose-response curve to the left. After phentolamine (8 mg kg-1 i.v.), adrenaline administered intra-arterially exerted beta-adrenoceptor-mediated relaxation of the nictitating membranes. However, there was no difference in the sensitivity or magnitude of responses between decentralized and control sides. In a separate series of experiments, the alpha-adrenoceptor-mediated contractile responses of the nictitating membrane to intra-arterial noradrenaline displayed supersensitivity on the decentralized side, the dose-response curve being significantly shifted to the left. In the same animals, the beta-adrenoceptor-mediated relaxation responses to intra-arterial isoprenaline were non-significantly greater on the decentralized side, presumably because of raised tone. However, when expressed as a percentage of the maximum relaxation, there was no difference in sensitivity. This study shows that the alpha-adrenoceptor-mediated contractile response of the nictitating membrane displays supersensitivity after preganglionic section of the sympathetic innervation. This is presumably because of an up-regulation arising from loss of sympathetic traffic onto the receptor. The relaxation response is mediated via adrenoceptors of the beta 2-subtype and shows no supersensitivity. This suggests that these receptors are not under the influence of the sympathetic innervation.

Animals↗
PubMed2006

Decentralized harmonic active vibration control of a flexible plate using piezoelectric actuator-sensor pairs.

We have investigated decentralized active control of periodic panel vibration using multiple pairs combining PZT actuators and PVDF sensors distributed on the panel. By contrast with centralized MIMO controllers used to actively control the vibrations or the sound radiation of extended structures, decentralized control using independent local control loops only requires identification of the diagonal terms in the plant matrix. However, it is difficult to a priori predict the global stability of such decentralized control. In this study, the general situation of noncollocated actuator-sensor pairs was considered. Frequency domain gradient and Newton-Raphson adaptation of decentralized control were analyzed, both in terms of performance and stability conditions. The stability conditions are especially derived in terms of the adaptation coefficient and a control effort weighting coefficient. Simulations and experimental results are presented in the case of a simply supported panel with four PZT-PVDF pairs distributed on it. Decentralized vibration control is shown to be highly dependent on the frequency, but can be as effective as a fully centralized control even when the plant matrix is not diagonal-dominant or is not strictly positive real (not dissipative).

Journal Article↗
PubMed2001

Anterior capsule contraction and intraocular lens decentration and tilt after hydrogel lens implantation.

AIM: To prospectively investigate changes in the area of the anterior capsule opening, and intraocular lens (IOL) decentration and tilt after implantation of a hydrogel IOL. METHODS: 100 patients underwent implantation of a hydrogel IOL in one eye and an acrylic IOL implantation in the opposite eye. The area of the anterior capsule opening, and the degree of IOL decentration and tilt were measured using the Scheimpflug videophotography system at 3 days, and at 1, 3, and 6 months postoperatively. RESULTS: The mean anterior capsule opening area decreased significantly in both groups. At 6 months postoperatively, the area in the hydrogel group was significantly smaller than that in the acrylic group. The mean percentage of the area reduction in the hydrogel group was also significantly greater than that in the acrylic group, being 16.9% in the hydrogel group and 8.8% in the acrylic group. In contrast, IOL decentration and tilt did not progress in either group. No significant differences were found in the degree of IOL decentration and tilt throughout the follow up period. CONCLUSIONS: Contraction of the anterior capsule opening was more extensive with the hydrogel IOL than with the acrylic IOL, but the degree of IOL decentration and tilt were similar for the two types of lenses studied.

Acrylic Resins↗
PubMed1998

The role of capsulotomy and intraocular lens type on tilt and decentration of polymethylmethacrylate and foldable acrylic lenses.

The purpose of this study is to determine the effects of different anterior capsulotomy techniques and intraocular lens (IOL) types on IOL tilt and decentration. For this purpose the device using Purkinje reflections and photographic documentation were evaluated. A total of 107 cataractous eyes undergoing IOL implant surgery were divided into four groups based on the type of IOL and capsulotomy: group 1, single-piece polymethylmethacrylate (PMMA) IOL with a haptic distance of 13.50 mm; group 2, single-piece PMMA IOL with 12. 0 mm overall length; group 3, three-piece foldable acrylic IOL with 13.00 mm PMMA haptic distance; group 4, the same IOL as group 1. While continuous circular capsulorhexis was the type of capsulotomy in the first three groups, envelope capsulotomy was used in group 4. Mean tilt and decentration were significantly less when capsulorhexis technique was used in comparison with envelope capsulotomy. Mean tilt of group 1 (2.83+/-0.89 degrees) and mean decentration of group 2 (0.28+/-0.14 mm) were higher within the first three groups. The differences regarding both the IOL decentration and tilt between the first three groups were statistically significant. This study shows that if the IOLs were placed properly in the capsular bag after continuous circular capsulorhexis, foldable acrylic IOLs with PMMA haptics are superior in terms of tilt and decentration.

Acrylates↗
PubMed1997

Attempts to decentralize in recent Brazilian health policy: issues and problems, 1988-1994.

Decentralization became an official policy in the Brazilian health sector after the fall of the military regime of 1964-1985. In this article the author reviews the concept and types of decentralization, with particular attention to the process of decentralization itself. There is a gap between the type of decentralization (devolution) called for in the national constitution and the deconcentration of activities actually implemented. This gap is explained by Brazil's centralist tradition and its supporters, staff resistance at the national level, and the weakness of local governments. Several methods could be used to redirect the reforms toward their original purpose, such as improving community participation, establishing a clear agenda for the decentralization process, and setting up some mechanisms to enhance this policy.

Brazil↗
PubMed1989

Evaluation of mobile cart decentralization.

The purpose of this study was to evaluate the effects of mobile cart decentralization of pharmacy services. The specific objectives of this study were to measure and compare (1) the average time to process a medication order and (2) the satisfaction of the nursing personnel with pharmacy services before and after decentralization. After decentralization, the average medication turn-around time decreased from 30 minutes to 12 minutes. Also, survey results indicate that nursing satisfaction with pharmacy services increased significantly after decentralization. This study measures two important benefits of decentralization. The next step is to measure the costs associated with this system.

Centralized Hospital Services↗
PubMed2003

Decentralization and equity of resource allocation: evidence from Colombia and Chile.

OBJECTIVE: To investigate the relation between decentralization and equity of resource allocation in Colombia and Chile. METHODS: The "decision space" approach and analysis of expenditures and utilization rates were used to provide a comparative analysis of decentralization of the health systems of Colombia and Chile. FINDINGS: Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation. In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization--the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization. This suggests that improved equity of funding over time might reduce inequities of service utilization. CONCLUSION: Decentralization can contribute to, or at least maintain, equitable allocation of health resources among municipalities of different incomes.

Chile↗
PubMed2004

The decentralization of the health system in Colombia and Brazil and its impact on leprosy control.

Decentralization policies are an integrated component of health sector reform in an increasing number of countries. The ability of such policies to improve the health system's quality and efficiency is backed up by limited scientific evidence. This study intends to evaluate the impact of decentralization on a specialized field of disease control (leprosy control) in Colombia and Brazil. It analyses the respective juridical base, epidemiological indicators and local publications. Furthermore, 39 semi-structured interviews with key informants were conducted. In both countries, the devolution of technical responsibility and financial resources to the municipalities was the implemented form of decentralization. Access to preventive and curative health care and the community participation in decision-making improved clearly only in Brazil. The decentralization to private providers in Colombia had dubious effects on service quality in general and still more on public health. The flow of finances (including finance collection through state-owned taxes instead of insurance companies) seemed to be better controlled in Brazil. Leprosy control in Brazil took advantage of the decentralization process; in Colombia, it came close to a collapse.

Brazil↗
PubMed2005

Decentralization and recentralization: effects on the health systems in Lao PDR.

In Lao PDR, lack of skilled manpower and financial resources in the central government, plus the policy urging local authorities to be self-sufficient and self-reliant caused the central government to decentralize all sectors to the provincial level in 1987. After 1987, the provinces took over all responsibilities such as planning, financing and provision of health services, only informing the Ministry of Health (MOH) about their activities. Because of economic differences between the 18 provinces, health services became unequal between the richer and poorer provinces. Some provinces generated high revenues, leading to over spending. The decentralized system had some negative impacts on the health service. The technical and planning functions managed from the ministry level became separated from management and financial decision making at the local level, and the ministry lost influence on the direction of health policy. Salaries from the local government were often delayed. Because health budgets were not allocated centrally by the Ministry of Health, there were no mechanisms by which health resources could be distributed preferentially to poorer areas with greater need. However, donors continued to support health programs through the Ministry of Health, sending drugs, vaccines, and other supplies to the provinces. The implementation of decentralization faced many difficulties due to the lack of experienced staff and insufficient training required for practicing decentralization. Similar problems in other sectors, such as agriculture, education, and communication, caused the central government to retake control from the provinces in 1992. During the recentralization period, utilization of health facilities increased. The Ministry of Health set rules and established regulations to strengthen the health system. A cost-recovery system was introduced to obtain additional funds, and conditions in the provinces gradually improved. The unique situation of decentralization followed by recentralization provides an excellent opportunity for study. We reviewed documents relating to these periods and interviewed officials at all levels who were concerned with the process.

Budgets↗
PubMed1990

Time and cost requirements for decentralized pharmacist activities.

Time and cost requirements for pharmaceutical services in patient-care areas at a 548-bed university hospital were studied. The study was conducted in 1987 and 1988 to (1) define the clinical and distributive activities of decentralized pharmacists, (2) develop time standards for each activity, (3) determine whether the time requirements of decentralized pharmacists depend on the type of patient involved, (4) determine the actual costs of decentralized pharmacist services for various types of patient, and (5) compare costs with reimbursement for clinical pharmacy services. Time standards were established based on data from seven patient categories representing a cross section of the institution's patients. The mean frequency of each activity and the total time and cost per patient day for all activities were determined. Pharmacist time spent daily in each patient-service category ranged from 2.3 hr for low-intensity medical care to 20.8 hr for trauma-burn intensive care. Decentralized pharmacists spent approximately 50% of their time on clinical activities in all patient-service categories. The daily cost per patient day for clinical activities was lowest for low-intensity medical care and highest for adult intensive care. The institution's daily charge for clinical activities ($10/admission and $10/day) exceeded the cost of clinical services during the study period. The decentralized pharmacist time requirement per patient day, and thus the costs of delivering pharmaceutical services, varied by patient-service category. The provision of clinical services generated a profit. A pharmacy workload analysis system that can identify costs and correlate them with patient types can be valuable in hospital pharmacy management.

Centralized Hospital Services↗
PubMed1982

The Kerala Decentration Meter. A new method and devise for fitting the optical of spectacle lenses in the visual axis.

Centring of spectacle lenses is much neglected field of ophthalmology. The prismatic effect caused by wrong centring results in a phoria on the eye muscles which in turn causes persistent eyestrain. The theory of visual axis, optical axis and angle alpha is discussed. Using new methods the visual axis and optical axis of 35 subjects were measured. The results were computed for facial asymmetry, parallax error, angle alpha and also decentration for near vision. The results show that decentration is required on account of each of these factors. Considerable correction is needed in the vertical direction, a fact much neglected nowadays; and vertical decentration results in vertical phoria which is more symptomatic than horizontal phorias. Angle Alpha was computed for each of these patients. A new devise called 'The Kerala Decentration Meter' using the pinhole method for measuring the degree of decentration from the datum centre of the frame, and capable of correcting all the factors described above, is shown with diagrams.

Asthenopia↗