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PubMed2000

No guarantees, only opportunities: an interview with Rodney J. Lisonbee.

Rodney J. Lisonbee, MAcc, CPA, is chief financial officer of the Urban South Region of Inter-mountain Health Care. IHC is a vertically integrated, not-for-profit healthcare system providing service in Utah and Idaho. Operations of the Urban South Region include three hospitals, seven physician clinics, and a home healthcare agency. Lisonbee's entire career in health care has been with Intermountain. He joined the organization in 1985 as director of accounting for Intermountain's LDS Hospital in Salt Lake City, Utah and assumed the CFO position with the Urban South Region in 1988.

Administrative Personnel↗
PubMed1975

The effect of several crude oils and some petroleum distillation fractions on intestinal absorption in ducklings (Anas platyhynchos).

Ducklings given hypertonic saline drinking water show significant increases in the rates of Na+ and water transfer across the intestinal mucosa. These increased rates of transfer are maintained as long as the birds are fed dypertonic saline. Oral administration of a single small dose of crude oil had no effect on the basal rate of mucosal transfer in freshwater-maintained ducklings but the adaptive response of the mucosa is suppressed in birds given hypertonic saline. When crude oils from eight different geographical locations were tested, the degree of inhibition varied between them; the greatest and smallest degrees of inhibition being observed following administration of Kuwait and North Slope, Alaska, crude oils respectively. The effects of distallation fractions derived from two chemically different crude oils were also examined. The volume of each distallation fraction administered corresponded to its relative abundance in the crude oil from which it was derived. The inhibitory effect was not associated exclusively with the same distallation fractions from each oil. A highly naphthenic crude oil from the San Joaquin Valley, California, showed the greatest inhibitory activity in the least abundant (2%), low boiling point (smaller than 245 degrees C) fraction and the least inhibitory activity in the highest boiling point (greater than 482 degrees C) most abundant (47%) fraction. In contrast, a highly paraffinic crude oil from Paradox Basin, Utah, showed the greatest inhibitory effect with the highest boiling point fraction and a minimal effect with the lowest boiling point fraction; the relative abundances of these two fractions in the crude oil represented 27 and 28% respectively. Water-soluble extracts of both crude oils also had inhibitory effects on mucosal transfer rates and these roughly proportionate to the inhibitory potency of the low boiling point fraction of each oil. Weathered samples of San Joaquin Valley, California, and the Paradox Basin, Utah, oils showed greater effects than corresponding samples of unweathered oils even though most of the low molecular weight material from both oils was either evaporated or solubilized in the underlying water during the 36-h weathering period.

Animals↗
PubMed1975

Determination of regional manpower requirements in obstetrics and gynecology.

The number of trainees produced by a residency program must relate directly to manpower needs in a specialty, not to the service needs of the training institution. In order to avoid geographic maldistribution of specialists, it is preferable to determine correct trainee output on a regional basis and combine such information inductively to determine overall national needs. A model for determination of the number of residents appropriate to train in obstetrics and gynecology by 1985 in the University of Utah program has been constructed in the setting of regional requirements. Components of this model include detailed population growth forecasts at the county level, consideration of the impact of increased urbanization, age-specific data for attrition of regional specialists by death or retirement, and estimation of the proportion of regional requirements to be met by the University of Utah program on the basis of distribution data of previous graduates.

Education, Medical, Graduate↗
PubMed1990

Temporal dimensions of the fertility transition: an age-period-cohort analysis of frontier fertility.

"This paper evaluates age, period, and cohort effects on marital fertility during onset of the Utah fertility transition (1880-1900). Computerized genealogies are used to derive age-period-cohort fertility rates for 49,842 once-married couples. Age, period and cohort effects on marital fertility are then estimated using Johnson's (1985) relational model. Declining marital fertility in Utah is shown to be explained by both lower fertility levels across periods and increasing age-specific limitation across cohorts. Direct cohort effects on fertility are insignificant. These results are consistent with prior research, and the view that fertility levels were adaptive (in part through birth spacing across ages) to immediate contexts of childbearing while age-specific fertility truncation increased across cohorts (in part through the more general diffusion of contraceptive innovations)."

Age Factors↗
PubMed1992

Development of a program for neonatal intensive care units managed by neonatal nurse practitioners.

Because of reduced medical coverage and changing educational experiences of the pediatric residents, the Department of Nursing Practice at the University of Utah Hospital in collaboration with the Department of Patient Care Services at Primary Children's Medical Center seized the opportunity to develop a nurse-managed patient care service within two tertiary-level nurseries in the State of Utah. Collaboration with nursing administrators and practitioners in both sites yielded joint plans for a successful NNP program. Initial efforts were to fund jointly and support the College of Nursing to develop an educational program, whereas the clinical program was developed before the reduction in medical coverage. Many issues were addressed because of the multidisciplinary and multi-institutional nature of the program. Work is ongoing in the recruitment of students and NNPs, development and review of clinical practice, and endorsement and privileging considerations.

Hospitals, Pediatric↗
PubMed1991

Complex segregation analysis of autism.

A complex segregation analysis of autism in 185 Utah families was carried out using the mixed model. The 209 affected individuals in these families represent nearly complete ascertainment of the autistic cases born in Utah between 1965 and 1984. The sibling recurrence risk for autism was 4.5% (95% confidence limits 2.8%-6.2%). Likelihoods were maximized for major-gene models, a polygenic model, a sibling-effect model, and a mixed model consisting of major-gene and shared-sibling effects. The analysis provided no evidence for major-locus inheritance of autism. Subdivision of the sample according to the probands' IQ levels showed that sibling recurrence risk did not vary consistently with IQ level. A segregation analysis of families in which the proband had an IQ less than 50 also failed to provide evidence for a major locus. However, because of the etiologic heterogeneity of this disorder, genetic analysis of other meaningful subsets of families could prove informative.

Autistic Disorder↗
PubMed1991

Computerized surveillance of adverse drug events in hospital patients.

OBJECTIVE: To develop a new method to improve the detection and characterization of adverse drug events (ADEs) in hospital patients. DESIGN: Prospective study of all patients admitted to our hospital over an 18-month period. SETTING: LDS Hospital, Salt Lake City, Utah, a 520-bed tertiary care center affiliated with the University of Utah School of Medicine, Salt Lake City. PATIENTS: We developed a computerized ADE monitor, and computer programs were written using an integrated hospital information system to allow for multiple source detection of potential ADEs occurring in hospital patients. Signals of potential ADEs, both voluntary and automated, included sudden medication stop orders, antidote ordering, and certain abnormal laboratory values. Each day, a list of all potential ADEs from these sources was generated, and a pharmacist reviewed the medical records of all patients with possible ADEs for accuracy and causality. Verified ADEs were characterized as mild, moderate, or severe and as type A (dose-dependent or predictable) or type B (idiosyncratic or allergic) reactions, and causality was further measured using a standardized scoring method. OUTCOME MEASURE: The number and characterization of ADEs detected. RESULTS: Over 18 months, we monitored 36,653 hospitalized patients. There were 731 verified ADEs identified in 648 patients, 701 ADEs were characterized as moderate or severe, and 664 were classified as type A reactions. During this same period, only nine ADEs were identified using traditional detection methods. Physicians, pharmacists, and nurses voluntarily reported 92 of the 731 ADEs detected using this automated system. The other 631 ADEs were detected from automated signals, the most common of which were diphenhydramine hydrochloride and naloxone hydrochloride use, high serum drug levels, leukopenia, and the use of phytonadione and antidiarrheals. The most common symptoms and signs were pruritus, nausea and/or vomiting, rash, and confusion-lethargy. The most common drug classes involved were analgesics, anti-infectives, and cardiovascular agents. CONCLUSION: We believe that screening for ADEs with a computerized hospital information system offers a potential method for improving the detection and characterization of these events in hospital patients.

Adolescent↗
PubMed1986

Air ambulance regulations: a model.

Prior attempts at establishing minimal federal air ambulance regulations and standards have been unsuccessful. However, reports of poor patient medical care during transport by some air ambulance services is now forcing many states to initiate air ambulance regulations. In 1984, the State of Utah Emergency Medical Services convened a special subcommittee to develop aeromedical regulations for the State of Utah. Using a three-level approach based upon the patient's requirements for basic, advanced, or specialized medical care and the urgency of transport, the subcommittee was able to derive medical categories necessary for the selection and utilization of air ambulance services. Minimum air ambulance regulations were then established for aircraft configuration, flight crew requirements, minimal equipment and medications, and the responsibilities of the medical director or designee for each of the three levels of medical care. We conclude that the application of a levels approach based upon the patient's medical requirements may be useful in assisting other states attempting to establish flexible but specific regulations directed at the safe transport of patients by aeromedical evacuation.

Aircraft↗
PubMed1980

Cancer mortality among Mormons in California during 1968--75.

On the basis of Church records, detailed cancer and total death rates were determined for an average of 360,000 California Mormons during 1968--75, for an average of 700,000 Utah Mormons during 1970 and 1975, and for a subgroup of active Mormon males known as High Priests and Seventies. For cancer as a whole, the standardized mortality ratio was 68% for all California Mormon males, 83% for all California females, and 50% for active Mormon males in California and Utah compared with 1970 U.S. whites. Age-specific and age-adjusted total mortality rates were substantially lower in Mormons than in 1970 U.S. whites, with the greatest differences occurring between 35 and 65 years of age, where the rates for active Mormon males were reduced by more than 60%. Methodologic issues and sources of error were discussed, and the overall quality of the data was good. Some health-related characteristics of Mormons are also summarized.

Adult↗
PubMed1993

Nurses' beliefs and attitudes toward visiting in adult critical care settings.

OBJECTIVE: To assess the beliefs and attitudes of critical care nurses about the effects of visiting on patients, staff and family. DESIGN: Both interviews and questionnaires were used to gather data on nurses' attitudes and beliefs about visiting and open visiting according to the format of Ajzen and Fishbein's Theory of Reasoned Action. SETTING: Five Utah intensive care units and three Ohio intensive care units. SAMPLE: Critical care nurses in Utah (N = 29) and Ohio (N = 41) were interviewed to assess their beliefs about the effects of visiting on patients, families, nurses and nursing care delivery. RESULTS: Nurses believed the consequence of visiting was more positive for the patient from a psychological perspective than from a physiological perspective but that the effects might differ depending on the patient, the visitor and the circumstances. They believed that visiting had negative consequences for families, because they became exhausted, and that visiting was disruptive for nursing care delivery. Their attitudes about effects of visiting on nursing staff were consistently more negative than were attitudes about the effects on the patient and the family. CONCLUSION: To provide an optimal situation for visiting, its negative consequences must be minimized and nurses' attitudes and beliefs about visiting must be assessed and addressed.

Adult↗
PubMed1993

A cohort study of thyroid disease in relation to fallout from nuclear weapons testing.

OBJECTIVE: To estimate individual radiation doses and current thyroid disease status for a previously identified cohort of 4818 schoolchildren potentially exposed to fallout from detonations of nuclear devices at the Nevada Test Site between 1951 and 1958. DESIGN: Cohort analytic study. SETTING: Communities in southwestern Utah, southeastern Nevada, and southeastern Arizona. PARTICIPANTS: Individuals who were still residing in the three-state area (n = 3122) were reexamined in 1985 and 1986, and information on the subjects' and their mothers' milk and vegetable consumption during the fallout period was obtained by telephone interview (n = 3545). After exclusions to eliminate missing data and confounding factors, 2473 subjects were available for analysis. MAIN OUTCOME MEASURES: Individual radiation doses to the thyroid were estimated by combining consumption data with radionuclide deposition rates provided by the US Department of Energy and a survey of milk producers. Relative risk models adjusted for age, sex, and state were fitted using maximum likelihood to period prevalence data for thyroid carcinomas, neoplasms, and nodules. RESULTS: Doses ranged from 0 mGy to 4600 mGy, and averaged 170 mGy in Utah. There was a statistically significant excess of thyroid neoplasms (benign and malignant; n = 19), with an increase in excess relative risk of 0.7% per milligray. A relative risk for thyroid neoplasms of 3.4 was observed among 169 subjects exposed to doses greater than 400 mGy. Positive but nonsignificant dose-response slopes were found for carcinomas and nodules. CONCLUSIONS: Exposure to Nevada Test Site-generated radioiodines was associated with an excess of thyroid neoplasms. The conclusions are limited by the small number of exposed individuals and the low incidence of thyroid neoplasms.

Adolescent↗
PubMed1977

A survey of attitudes toward two motivating factors.

A survey was conducted to determine the attitudes clinical laboratory workers in Utah had toward two intrinsic aspects of work, challenge or appeal of work and self-fulfillment. Questionnaires were distributed to all major hospitals in Utah. Frequency distributions were obtained and Chisquare tests were performed to determine if significant differences existed in relationship to demographic variables. Respondents indicated that work was interesting, challenging, required thinking, and enabled them to make good use of past training, skills, and abilities. Findings showed they also responded positively to statements involving ample responsibility given for the position held, contribution to patient care, enjoyment of work, and feeling of self-importance. Negative attitudes were noted toward statements dealing with advancement in medical technology, adequate opportunities for continuing education at employer expense, and participation in decision making. The Chi-square test revealed workers in the hospitals surveyed differed significantly in their opinions about having adequate opportunities to attend workshops, etc., on employer time and expense, and also that personnel with varying educational levels felt significantly different about making suggestions concerning the laboratory.

Adult↗
PubMed1996

Four Corners Research Consortium for Native Americans and cancer research.

Cancer morbidity and mortality in Native Americans in the Southwestern four-corners region of the United States (Arizona, Colorado, New Mexico, and Utah) is of critical concern to public health workers, health care providers, cancer researchers, and Native American communities of the region. As a follow-up to the national conference in Seattle, Washington, representatives from the Arizona, Colorado, New Mexico, and Utah Cancer Centers, the AMC Cancer Research Center, and the Indian Health Service participated in a regional conference on September 26, 1995. The primary reason for the "Four Corners Consortium" meeting was to assess cancer research activities in each state and to determine how Native American cancer research could be organized in the four-state region. One interest of the group was to determine strategies to explore why some cancers are more or less prevalent among Southwest Native American populations and to evaluate how the group might jointly establish research that would address the cancer needs of Southwestern tribes.

Arizona↗
PubMed1994

Decreased plasma concentrations of the C4B complement protein in autism.

OBJECTIVE: To determine complement C4 protein concentrations in the plasmas of autistic subjects and their family members. DESIGN: Cross-sectional study. SETTING: Center for Persons with Disabilities and the Department of Biology, Utah State University, Logan. PARTICIPANTS: Forty-two autistic subjects (34 males [81%] and eight females [19%]), 50 of their biologic parents, 21 siblings, and 105 normal subjects (56 females [53%] and 49 males [47%]; all white) living in northern Utah. INTERVENTIONS: None. METHODS: The enzyme-linked immunosorbent assay was used to determine C4 protein concentrations in autistic subjects. MAIN RESULTS: Plasma concentration (median, 14.7 g/L of the C4B protein) in autistic patients was significantly (P = .01) decreased compared with that of normal subjects (median, 22.4 g/L). The C4B concentrations in parents and siblings of autistic children were decreased, but not significantly. The C4A protein concentrations in the plasma of autistic subjects and their family members were normal. CONCLUSION: Decreased protein concentrations of C4B may be associated with autism.

Adolescent↗
PubMed1985

Value of open-lung biopsy in 87 immunocompromised patients with pulmonary infiltrates.

The authors performed a retrospective analysis of 87 consecutive immunocompromised patients who underwent open-lung biopsy at the University of Utah Medical Center, Salt Lake City, Utah, from January 1971 to June 1982. A specific histologic diagnosis was obtained in 62 (71%) of the patients, 33 of whom had infections. Pneumocystis carinii was the most common microbial pathogen (16 patients), but no cases have been observed since 1980 when the routine use of prophylactic trimethoprim/sulfa began. The other specific diagnoses included malignancy or drug-induced lung disease. Specific therapy was available for 52 patients, and in 33 cases, a change in therapy was necessary to treat according to the lung biopsy diagnosis. Forty-one patients received an adequate course of therapy and 27 (66%) of these improved clinically, including 16 of 26 patients with infections, 11 of 14 with malignancies, and 1 of 2 with a vasculitis. Among the subgroup of 33 patients for whom a new, specific therapeutic option was available as a result of the biopsy diagnosis 21 (64%) responded to the treatment. Eleven significant operative complications were encountered, but no deaths were attributable to the biopsy. An open-lung biopsy in immunocompromised patients is a relatively safe, accurate diagnostic procedure which frequently facilitates appropriate therapy and clinical improvement.

Adolescent↗
PubMedDate not supplied

Cybernetic aspects of bone modeling and remodeling, with special reference to osteoporosis and whole-bone strength.

Assume mythical physiologists were taught that renal physiology and its disorders depend on "kidney cells" and their regulation by nonmechanical factors, but were taught nothing about nephrons. For decades they "knew" that idea was correct, just as Ptolemy "knew" the universe centers on our planet. But then others began to describe nephrons, their roles in renal physiology and disorders, and problems they revealed in former views, so doubts and controversies began. Today real physiologists encounter a similar situation for bone health and its disorders. A 1960 paradigm attributed such things to bone's effector cells (osteoblasts and osteoclasts) and their regulation by nonmechanical factors, without "nephron-equivalent" or biomechanical input. But both mechanical and nonmechanical factors regulate bone's nephron equivalents. Adding features of those equivalents to the 1960 views led to the Utah paradigm, which suggests problems in former views and better explanations for "osteoporosis," whole-bone strength, and other bone disorders. Such things incited controversies among current skeletal physiologists. Cybernetics concerns the relationships, mechanisms, signals, and message traffic that help to control the behavior and other features of dynamic systems. A cybernetic analysis of the bone physiology in the Utah paradigm can add many features to the 1960 paradigm that help to understand osteoporoses, other bone disorders, and whole-bone strength (and bone mass). The added features also show new and pertinent targets for the related research.

Bone Development↗
PubMed2005

XK-aprosencephaly and related entities.

We offer further biological characterization of the XK atelen/aprosencephaly syndrome in two infants, one with prolonged survival, the other presenting prenatally with apparent hydranencephaly and an orbital tumor (OS). Familial occurrence in the former born to presumably nonconsanguineous Lybian parents may represent parental germinal mosaicism or autosomal recessive inheritance. Both had apparently normal chromosomes; however, the Lybian infant had slightly increased induced chromosome breakage suggesting that this rare multiple congenital anomalies syndrome may involve a DNA repair defect. Virtual absence of atelen/aprosencephalic structures may lead to an arthrogryposis-like prenatal movement disorder. The orbital tumor in the Utah infant consisted of dystopic neural tissue compressing a rudimentary globe and was connected by a thin bridge of neural tissue to the small mass of disorganized brain tissue usually found in atelen/aprosencephalic infants and fetuses. No evidence of an encephaloclastic process was found in the autopsied Utah infant.

Abnormalities, Multiple↗
PubMed1983

Propagation of Aleutian disease parvovirus in cell line CCC clone 81.

Aleutian disease parvovirus (ADV), mutant Gorham of the Utah-1 strain, was grown and comparatively assayed in feline cell lines CRFK and CCC clone 81 at 31.8 degrees C. The maximum virus titres as determined by a fluorescent focus assay were found to be about 10(5) FFU/ml in CRFK at day 6 p. i. and 10(6) FFU/ml at day 4 p. i. in CCC clone 81 cells. Shifting of the incubation temperature from 31.8 to 37 degrees C led to a reduced virus production after three passages. The synchronization of the CCC clone 81 cells by 1 X 10(-3) M hydroxyurea followed by infection with low (less than or equal to 0.8) multiplicities of infection (MOI) did not significantly influence the virus titres. Several mammalian cell lines such as MiCl 1 (S+L-), Mv1-Lu, 64F3 clone 7 and FEF or fish cell lines such as BB and CHSE 114 developed abortive infections after inoculation with the temperature-sensitive mutant Gorham of the ADV strain Utah-1 (ADV-G). Three new isolates designated ADV-Sl1--ADV-Sl3 were isolated from spleen and blood lymphocytes and bone marrow cells of ADV-infected mink and were adapted to grow in CCC clone 81 cells at 31.8 degrees C with virus titres between 10(4) and 10(4.7) FFU/ml. ADV particle populations varying in their bouyant density between 1.32, 1.36 and 1.43 g/ml were isolated from infected cells and culture supernatants. By protein blotting and immunodetection two major protein components with apparent M. W. of 85 and 75 KD and three minor polypeptides of 33, 28.9 and 27.5 KD were detected.

Aleutian Mink Disease↗