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PubMed1990

Using matrix organization to manage health care delivery organizations.

Matrix organization can provide health care organization managers enhanced information processing, faster response times, and more flexibility to cope with greater organization complexity and rapidly changing operating environments. A review of the literature informed by work experience reveals that the use of matrix organization creates hard-to-manage ambiguity and balances of power in addition to providing positive benefits for health care organization managers. Solutions to matrix operating problems generally rely on the use of superior information and decision support systems and extensive staff training to develop attitudes and behavior consistent with the more collegial matrix organization culture. Further improvement in understanding the suitability of matrix organization for managing health care delivery organizations will involve appreciating the impact of partial implementation of matrix organization, temporary versus permanent uses of matrix organization, and the impact of the ambiguity created by dual lines of authority upon the exercise of power and authority.

Communication↗
PubMed1996

[The vomeronasal organ--a rediscovered sensory organ].

The authors review the function and anatomy of the vomeronasal organ (organ of Jacobson), a chemosensory organ situated in the nose. In mammals, stimulation of the vomeronasal organ induces sexual behaviour and changes the hormonal status of males and females. Impairment of the vomeronasal organ in rats disrupts both the females' ultrasound calling during oestrus and their maternal behaviour. Stimulation of the vomeronasal organ promotes sexual maturation of juvenile females and induces abortion and production of pheromones. Earlier on, the vomeronasal organ in man was believed to be present only at the foetal stage; in 1991 its presence was reestablished in adults. Electrophysiological studies show that the vomeronasal organ of man is stimulated by steroids found in human skin. The physiological properties of the receptor cells of the vomeronasal organ are different from those of the olfactory organ.

Adolescent↗
PubMed1992

Is the adoption of more efficient strategies of organ procurement the answer to persistent organ shortage in transplantation?

[I]s persistent organ shortage the major obstacle to the performance of more procedures as often popularly portrayed? Does the answer therefore lie in the adoption of more efficient strategies of organ procurement? While the measures taken to improve the efficiency of organ procurement may be inspired by the laudable motive of saving lives, they may ultimately prove to be myopic if the larger ethical issues raised by organ transplant programs for the allocation of national and organ resources are not given their due consideration. For any society that desires to include organ transplantation in its health delivery system, it must consider the social and ethical issues that transplant programs raise for the macroallocation of available national resources and the manner by which organ resources are procured, and distributed. The failure to resolve these issues in an ethically acceptable manner at any of these levels would render any transplant program ethically indefensible. This essay therefore argues that before a society decides on its policy of organ procurement it ought to make prior assessments of: a) its social priorities; b) the policies for ensuring fair access to organ resources; and c) the extent to which it is willing to support transplants.

Cadaver↗
PubMed1982

Comparative study of ultrastructures of the lateral-line organs and the palatal taste organs in the African clawed toad, Xenopus laevis.

The fine structure of the lateral-line organ and the palatal taste organ in the African clawed toad, Xenopus laevis, was examined by means of electron microscopy. The lateral-line organ consisted of hair and accessory cells. The apical surface of a hair cell was studded with one kinocilium and 20 to 40 stereocilia. Synaptic bodies and subsynaptic cisternae were found in the cytoplasm of a hair cell adjacent to the synaptic contacts with the afferent and the efferent nerve endings, respectively. Crystalline bodies were observed in both the nucleoplasm and the cytoplasm of almost all hair cells. The palatal taste organ consisted of three types of cells: the taste, sustentacular, and the Merkel cells. The taste cells contained numerous dense-cored vesicles which accumulated in close association with both the afferent synapses and the basal plasma membrane. The possibility was raised from the ultrastructural results that these vesicles had dual functions as both neurotransmitter and hormone. The existence of Merkel cells in the palatal taste organ suggested that this organ might function not only as a chemoreceptor but also as a mechanoreceptor. In spite of possible chemosensory function of the lateral-line organ in Xenopus, its ultrastructure was significantly different from that of the typical gustatory organ, the palatal taste organ, in this animal.

Animals↗
PubMed2005

Antioxidant effectiveness of organically and non-organically grown red oranges in cell culture systems.

BACKGROUND: Consumers consider plant food products from organic origin healthier than the corresponding conventional plant foods. Clear experimental evidence supporting this assumption is still lacking. AIM OF THE STUDY: To determine if the organic red oranges have a higher phyto-chemical content (i. e., phenolics, anthocyanins and ascorbic acid), total antioxidant activity and in vitro bioactivity, in terms of protective effect against oxidative damage at cellular level, than nonorganic red oranges. METHODS: Total phenolics were measured using the Folin Ciocalteau assay, while total anthocyanins and ascorbic acid levels were determined by spectrophotometric and HPLC analysis, respectively. In addition, the total antioxidant activity of red orange extracts was measured by the ABTS(*+) test. The ability of red orange extracts to counteract conjugated diene containing lipids and free radical production in cultured rat cardiomyocytes and differentiated Caco-2 cells, respectively, was assessed. RESULTS: Organic oranges had significantly higher total phenolics, total anthocyanins and ascorbic acid levels than the corresponding non-organic oranges (all p < 0.05). Moreover, the organic orange extracts had a higher total antioxidant activity than non-organic orange extracts (p < 0.05). In addition, our results indicate that red oranges have a strong capacity of inhibiting the production of conjugated diene containing lipids and free radicals in rat cardiomyocytes and differentiated Caco-2 cells, respectively. Statistically higher levels of antioxidant activity in both cell models were found in organically grown oranges as compared to those produced by integrated agriculture practice. CONCLUSIONS: Our results clearly show that organic red oranges have a higher phytochemical content (i. e., phenolics, anthocyanins and ascorbic acid), total antioxidant activity and bioactivity than integrated red oranges. Further studies are needed to confirm whether the organic agriculture practice is likely to increase the antioxidant activity of other varieties of fruits and vegetables.

Agriculture↗
PubMed1990

Knowledge regarding organ donation: identifying and overcoming barriers to organ donation.

Four-hundred and fifty-five undergraduate students, 26 MBA students, and 465 people from the surrounding community responded to 21 true/false questions regarding factual knowledge about organ donation. The mean number of correct answers was 74.6%. The correct response rate, however, varied widely over questions. Four questions with very large error rates suggest possible 'barriers to donation'. Specifically, these questions concerned religious support for organ donation, the concept of brain death, the normally rigid separation of physician teams who are primarily responsible for the welfare of the donor and donee, and a mistaken belief that to be valid an organ donor card must be filed with the U.S. Department of Health and Human Services. Knowledge of organ donation facts was found to be related to whether subjects carried or requested an organ donor card, their attitude towards organ donation and their willingness to donate their own organs or the organs of a deceased loved one. These findings suggest strategies for raising public support for organ donation.

Attitude to Health↗
PubMed2005

Immunocompetence of fattening pigs fed organic versus conventional diets in organic versus conventional housing.

The effect of organic or conventional feeding on the immune response of pigs was determined using organic or conventional housing in a pig fattening unit. The experimental design involved four pens of four animals per housing and diet combination (organic housing and organic nutrition; organic housing and conventional nutrition; conventional housing and organic nutrition and conventional housing and conventional nutrition). The IgM, IgA and IgG responses against intramuscularly injected bovine thyroglobulin were determined as indicators of the antigen-specific immune responsiveness. Some general health and welfare related parameters were evaluated by measuring haptoglobin concentrations at selected times; blood lactate concentration was measured at slaughter. Conventional housing led to a higher IgG response three weeks after the first immunisation. Organic housing led to lower haptoglobin and lactate concentrations at slaughter, indicating a higher stress resistance in these pigs. No major differences between the two feeding types were found. We conclude that the immune responses following either a conventional or an organic diet are comparable, whereas organic housing can increase stress resistance at slaughter compared to conventional housing.

Animal Feed↗
PubMed1996

Johnston's organ and central organ in Nezara viridula (L.) (Heteroptera, Pentatomidae).

The fine structure of Johnston's organ and central organ in Nezara viridula (Heteroptera, Pentatomidae) is described. Johnston's organ consists of 45 scolopidia distributed around the periphery of the distal part of the third antennal segment (distal pedicellite). The scolopidia are anchored separately in invaginations of joint cuticle between the pedicel and flagellum. The scolopidia are amphinematic and each scolopidium comprises three sensory cells and three enveloping cells. The latter are a proximal scolopale cell with a typical labyrinth, an attachment cell filled with many microtubules, and a distal accessory cell also filled with microtubules. Axons of 17 scolopidia gather and join one antennal nerve; 28 scolopidia of the opposite side, extend axons into the other antennal nerve. The central organ consists of seven mononematic scolopidia, which comprise of one or two sensory cells. They anchor in the same joint as the scolopidia of Johnston's organ. The sensory cell bodies of the central organ are located close to the antennal nerves, more proximally than those of Johnston's organ. The axons of four scolopidia join one antennal nerve and those of the remaining three scolopidia join the other antennal nerve. Enveloping cells similar to those in Johnston's organ are present in the central organ.

Animal Communication↗
PubMed1999

Factors influencing the potential organ donation: a 6-yr experience of the New Jersey Organ and Tissue Sharing Network.

UNLABELLED: The demand for organ transplants in the United States is increasing by 16% every year. Unfortunately, organ donation figures are not increasing at the same rate. Factors that influence the process of organ donation in New Jersey were analyzed. METHODS: A retrospective study in which the charts of actual and potential organ donors identified by the New Jersey Organ and Tissue Sharing Network (OTSN) between January 1990 and December 1995 were reviewed. Potential donors who were not identified by the OTNS or the United Network for Organ Sharing (UNOS) were not considered because no data relative to these cases were available. The conversion ratio (CR) between actual donor from potential donor was determined. A statistical analysis of the data was performed using multivariate regression logistic analysis. RESULTS: Organ donation increased, both in the male and female population, by 14% over the last 6 yr. The 0-5-yr age group experienced an increment in CR from 7.7 to 37.7% (p < 0.001). All other age groups had a continuous improvement, but a statistically significant increase over time was not observed. The CR of all races increased over the 6-yr study period. The Afro-American population donated significantly less than the white population (32.1 vs. 59.9%) (p < 0.001). The three transplant centers in New Jersey had a CR less than that seen in the non-transplant centers (38.1 vs. 44.1%). The number of total donations (78.7 vs. 21.3%) was significantly greater in the non-transplant centers (p < 0.001). Moreover, the number of lost donors was higher at transplant centers (p < 0.001). Over the 6-yr period, the difference between donations coming from non-urban (70.8%) versus urban areas (29.27%) was highly significant (p < 0.001). Traumatic deaths were associated with a greater CR (55.3%) than all other causes of death. The CR for donors dying as a result of motor vehicle accidents (MVA) (p < 0.001), penetrating trauma, and child abuse all increased. Level II trauma centers had a better CR (53.7%) than level I centers (48.4%) and non-trauma centers (51.1%). The donation rate was similar for level II and non-trauma centers (60%). CONCLUSIONS: The organ donation rate in New Jersey is not sufficient to meet the needs of organ recipients in New Jersey. Pediatric donations increased considerably, specifically from child abuse. MVA deaths are associated with the greatest CR. Urban areas have a worse CR than non-urban areas, even if they are associated with transplant or trauma

Female↗
PubMed1992

Prevalence of hepatitis C virus RNA in organ donors positive for hepatitis C antibody and in the recipients of their organs.

BACKGROUND: There is a high prevalence of liver disease among the recipients of organs from donors with antibodies to hepatitis C virus (HCV). We undertook a study to determine the frequency of persistent HCV infection, as indicated by the presence of HCV RNA, among both cadaveric organ donors positive for antibodies to HCV (anti-HCV) and the recipients or organs from these donors. METHODS: Serum samples from donors and recipients were tested for HCV RNA with the reverse transcriptase polymerase chain reaction, with use of primers from the 5' untranslated region of the HCV genome, and for anti-HCV with the first-generation enzyme-linked immunosorbent assay (ELISA) and two second-generation tests. RESULTS: HCV RNA was detected in 9 of the 11 organ donors (82 percent) with a positive first-generation ELISA for anti-HCV. Among the organ recipients, the prevalence of HCV RNA increased after transplantation: 7 of 26 patients (27 percent) had positive samples before transplantation, as compared with 23 of 24 patients (96 percent) after transplantation (P less than 0.001). Among 13 recipients who were HCV RNA-negative before receiving organs from the nine HCV RNA-positive donors, HCV infection was detected in all 13 after transplantation, and anti-HCV developed in 8 (62 percent). On the basis of a positive test for HCV RNA, the maximal sensitivity of the three anti-HCV tests was 57 percent (positive in 4 of 7 patients with end-stage organ failure) before transplantation and 70 percent (positive in 16 of 23 patients) after transplantation. CONCLUSIONS: Nearly all the recipients of organs from anti-HCV-positive donors become infected with HCV. The current tests for anti-HCV antibodies underestimate the incidence of transmission and the prevalence of HCV infection among immunosuppressed organ recipients.

Base Sequence↗
PubMed1996

Evaluation of a small organ procurement organization in the Basque country, Spain.

A limited supply of organs is the main obstacle for organ transplantation. The shortage reflects not only a shortage of donors but also a failure to make use of existing donors. The Basque Country Transplant Coordination Team is an organ procurement organization that operates in the Basque country, an area of 7260 km2 with 2.1 million inhabitants. From January 1, 1990, to December 31, 1995, the number of potential cadaveric organ donors found by the team increased, to 70 donors per million inhabitants in 1995. Since 1993, the organization has had more than 30 donors per million persons and has procured more than 90 cadaveric organs, including more than 60 cadaveric kidneys, per million persons. Because of these rates, the team coordinated 61.7 cadaveric kidney transplants per million persons during 1995. This paper describes some characteristics of the Basque organ procurement organization that might explain these results.

Humans↗
PubMed2006

Blood vessels recovered with organs and intended for use in organ transplantation. Direct final rule.

The Health Resources and Services Administration (HRSA) and the Food and Drug Administration (FDA) are amending their regulations to consider as part of an organ those blood vessels recovered with the organ that are intended for use in organ transplantation (HRSA regulation); and to exclude such blood vessels from the definition of human cells, tissues, and cellular and tissue-based products (HCT/Ps) (FDA regulation). We (HRSA and FDA) are taking this action to provide that blood vessels recovered with organs and intended for use in organ transplantation are governed by the regulations pertaining to organs. The regulation of other recovered blood vessels remains unchanged. We believe that this change will eliminate the unnecessary burden resulting from an organ procurement organization's efforts to comply with both FDA and HRSA rules with respect to blood vessels (FDA jurisdiction) and organs (HRSA jurisdiction). We are issuing these amendments directly as a final rule because they are noncontroversial, and there is little likelihood that we will receive any significant adverse comments. Elsewhere in this issue of the Federal Register, we are publishing a companion proposed rule under our usual procedures for notice and comment in the event that we receive any significant adverse comments on the direct final rule. If we receive any significant adverse comments that warrant terminating the direct final rule, we will consider such comments on the proposed rule in developing the final rule.

Blood Vessels↗
PubMed1992

The potential supply of organ donors. An assessment of the efficacy of organ procurement efforts in the United States.

OBJECTIVES: To estimate the potential supply of organ donors and to measure the efficiency of organ procurement efforts in the United States. METHODS: A geographic database has been developed consisting of multiple cause of death and sociodemographic data compiled by the National Center for Health Statistics. All deaths are evaluated as to their potential for organ donation. Two classes of potential donors are identified: class 1 estimates are restricted to causes of death involving significant head trauma only, and class 2 estimates include class 1 estimates as well as deaths in which brain death was less probable. RESULTS: Over 23,000 people are currently awaiting a kidney, heart, liver, heart-lung, pancreas, or lung transplantation. Donor supply is inadequate, and the number of donors remained unchanged at approximately 4000 annually for 1986 through 1989, with a modest 9.1% increase in 1990. Between 6900 and 10,700 potential donors are available annually (eg, 28.5 to 43.7 per million population). Depending on the class of donor considered, organ procurement efforts are between 37% and 59% efficient. Efficiency greatly varies by state and organ procurement organization. CONCLUSIONS: Many more organ donors are available than are being accessed through existing organ procurement efforts. Realistically, it may be possible to increase by 80% the number of donors available in the United States (up to 7300 annually). It is conceivable, although unlikely, that the supply of donor organs could achieve a level to meet demand.

Databases, Factual↗
PubMed1991

[Multiple organ failure. Reflection of generalized cell damage of all organs following severe trauma].

Multiple organ failure (MOF) is presently recognized as the most severe, and often lethal, complication after multiple trauma. Causal factors and pathomechanisms remain unclear, however. Generalized inflammatory cell tissue injury with a subsequent increase in permeability in all organs has been suggested. For this reason, 38 polytraumatized patients were examined in a prospective study. Organ function was analyzed, and specific clinical and histological studies were performed to check for generalized cell tissue damage and increased respiratory permeability. In all organs we found signs of tissue damage immediately after trauma. Disturbances of organ function were seen consistently, starting precisely from day 4. It was not possible to confirm an influence of blunt organ trauma on organ function during follow-up. The severity of injury (especially intrathoracic and intraabdominal) and massive bleeding increases the risk of MOF. MOF was not always associated with the onset of sepsis, and no temporal dependence could be shown. Histological studies demonstrated an inflammatory change in organ tissues, which is probably the result of toxic substances (endotoxin, TNF, oxygen radicals, proteases and eicanosoids) released into the blood circulation after trauma. Insufficient neutralization of these toxic metabolites leads to generalized permeability damage and consequently to progressive organ failure. Therefore, even with optimized initial treatment of multiple trauma patients, MOV and mortality can only be reduced with a causal approach to therapy.

Adolescent↗
PubMed1995

Organ and tissue donation in Louisiana: the 1994 experience of the Louisiana Organ Procurement Agency (LOPA).

The Louisiana Organ Procurement Agency (LOPA) operates the organ and tissue procurement system for the entire state. LOPA is experiencing an increase in referrals and actual donors, with 101 donors realized from 34 hospitals in 1994. From these donors, 398 organs were recovered to provide 275 kidney, liver, heart, pancreas, and lung transplants in Louisiana, and 97 organs were shared for transplant elsewhere. However, consent for donation was refused for 40% of medically suitable donors, creating a loss of 180-200 organs for transplant, many of which would have been lifesaving. Nationwide, the shortage of organs continues to worsen as waiting lists grow. This health care problem continues to generate corrective initiatives, such as "required request" and performance standards for the organ procurement organization. Ranked in the top group of procurement organizations, LOPA is well positioned to meet and help define new federal standards.

Humans↗
PubMed1989

The organization of organ procurement.

The American organ procurement system has improved and matured in the last five years. At the same time, the basic challenges facing it have remained substantially the same because the moral and legal framework of the system has not changed. Success at organ procurement continues to depend on the voluntary cooperation of medical professionals and the families of potential organ donors. The generosity of the American public is so great that the primary challenge facing organ procurement agencies is obtaining cooperation from hospitals and medical professionals. This calls for a "marketing" orientation aimed at those hospitals and professionals who are most likely to treat potential donors. The last five years have seen a more general acceptance of this appreciation of the central task of organ procurement. As a result, the overall effectiveness of the system has improved, as measured by the number of organs procured on a per capita basis and by the number of multiorgan donors obtained. Much of this improvement can be attributed to the diffusion of organizational techniques and approaches, and this diffusion has been encouraged by the involvement of national organizations and public bodies in the organ procurement community. The system remains uneven in its effectiveness and further improvement is possible. It is also possible that the next general round of improvement will result from the application of businesslike information management and marketing techniques.

Federal Government↗