Common ground: hospitals, physicians and outpatient centers.
Physician-owned ambulatory surgery centers are projected to keep growing. For at least one hospital, it's a sign to start partnering and stop competing.
Cooperative Behavior↗
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Results for “Project START”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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[The role of hospital personnel in quality assurance activities at Danish hospitals].
Over the last few years there has been considerable activity concerning quality assurance (QA) in health care. In order to investigate the actual consequences, we mailed a questionnaire to all Danish hospital managements, asking them to distribute it to leading doctors and nurses. 349 questionnaires from 51 hospitals were returned. The questionnaire was concerned with QA-activities, topics and methods, organisational aspects and attitudes amongst the professionals. Forty-eight percent of all hospitals, evenly distributed over all hospital and department categories, were represented in the survey. Fifty percent of respondents were doctors, 40% nurses. Eighty-seven percent had started quality assurance activities, typically clinically oriented research where doctors were concerned, and typically projects concerning communication with patients when initiated by nurses. Both groups had many projects concerning personnel policy, especially educational aspects. 3% of the activities were concerned with patient satisfaction. Knowledge of quality assurance principles was not yet widespread among the professionals, but 87% expressed positive attitudes. There is a need to define the concept of QA and to spread knowledge of QA-methods, if a systematic approach to QA is to be implemented.
Denmark↗
[Cammalanus Railliet and Henry, 1915 (Nematoda, Camallanidae). Parasite from Hydrodynastes gigas (Reptilia, Serpentes, Colubridae) from Argentine Chaco].
Adult specimens of Camallanus genus (Nematoda, Camallanidae), parasitizing a Hydrodynastes gigas (Serpentes, Colubridae) from Chaco in the North East of Argentina, are described for the first time. The morphologic and morphometric parasitological studies were carried out using diaphanization by lactophenol technique. The specimens described were drawn and photographed. With this investigation the analysis of the reptilian pathologies, the knowledge of which is necessary to make projects, to manage and control the biomedic aspects in breeders, zoos and/or reserves has started. Thus, it enables us to know associated nematofauna providing facts about the biodiversity of nematode parasites of reptiles.
Animals↗
DiI reveals a prenatal arrival of efferents at the differentiating otocyst of mice.
We have reinvestigated the time of arrival of efferent fibers at the developing otocyst of mice employing diffusion of the lipophilic dye DiI in fixed tissue. In contrast to almost all previous reports, our data indicate a prenatal arrival of efferent fibers. A few efferent fibers were found to enter the eighth nerve root at embryonic day (ED) 10 1/2. Retrogradely labelled efferent cell bodies were at this stage coextensive with those of the facial motor nucleus, but started to segregate by ED 12. In contrast to retrogradely labelled facial motor neurons, labelled efferent neurons were bilaterally distributed in the hindbrain with a few projecting to both otocysts as early as ED 12. Anterograde labelling from the brain showed efferent fibers in the vestibular ganglion by ED 11. Invasion of the future vestibular sensory epithelia started by ED 12. Growth cones of efferent fibers had also reached the future cochlear sensory epithelium but invasion was only achieved by a few filopodia at this stage. The early arrival of efferents at the future sensory epithelia demonstrated here may allow an as yet unexplored interaction of efferent fibers with the proliferating and/or differentiating hair cells.
Animals↗
Striking regression of subcutaneous fibrosis induced by high doses of gamma rays using a combination of pentoxifylline and alpha-tocopherol: an experimental study.
PURPOSE: To establish a successful treatment of subcutaneous fibrosis developing after high doses of gamma rays, suitable for use in clinical practice. METHODS AND MATERIALS: We used an animal model of acute localized gamma irradiation simulating accidental overexposure in humans. Three groups of 5 Large White pigs were irradiated using a collimated 192Ir source to deliver a single dose of 160 Gy onto the skin surface (100%) of the outer side of the thigh. A well-defined block of necrosis developed within a few weeks which had healed after 26 weeks to leave a block of subcutaneous fibrosis involving skin and skeletal muscle. One experimental group of 5 pigs was dosed orally for 26 weeks starting 26 weeks after irradiation with 1600 mg/120 kg body weight of pentoxifylline (PTX) included in the reconstituted food during its fabrication, and another group of 5 was dosed orally for the same period with a daily dose of 1600 mg/120 kg body weight of PTX combined with 2000 IU/120 kg body weight of alpha-tocopherol. Five irradiated control pigs were given normal food only. Animals were assessed for changes in the density of the palpated fibrotic block and in the dimensions of the projected cutaneous surface. Depth of scar tissue was determined by ultrasound. Physical and sonographic findings were confirmed by autopsy 26 weeks after treatment started. The density, length, width, and depth of the block of fibrotic scar tissue, and the areas and volume of its projected cutaneous surface, were compared before treatment, 6 and 13 weeks thereafter, and at 26 weeks. RESULTS: The experimental animals exhibited no change in behavior and no abnormal clinical or anatomic signs. No modifications were observed in the block of fibrotic scar tissue of pigs dosed with PTX alone. However, significant softening and shrinking of this block were noted in the pigs dosed with PTX + alpha-tocopherol 13 weeks after treatment started and at autopsy, when mean regression was approximately 30% for length, approximately 50% for width and depth, and approximately 70% for area and volume. Histologic examination showed completely normal muscle and subcutaneous tissue surrounding the residual scar tissue. The 50% decrease in the linear dimensions of the scar tissue, were comparable to the results obtained in our previous clinical studies, and were highly significant compared to the clinical and autopsy results for the controls. Histologic examination of the residual scar tissue revealed tissue which was more homogenous and less cellular and inflammatory than in control and PTX-dosed pigs. The tissular and cellular immunolocalization of tumor necrosis factor alpha (TNFalpha) was similar in the residual fibrotic tissues of all three groups of pigs, whereas the immunostaining of transforming growth factor beta-1(TGFbeta-1) diminished much more in the residual fibrotic scar tissue of the PTX + alpha-tocopherol-dosed pigs than in the two other groups. CONCLUSIONS: The present results showed a striking regression of the subcutaneous fibrotic scar tissue that develops as a consequence of high doses of gamma rays.
Drug Combinations↗
Management of rural drinking water supplies and waste using the participatory hygiene and sanitation transformation (PHAST) initiative in Zimbabwe.
This paper focuses on the use of Participatory Hygiene and Sanitation Transformation (PHAST) and how the methodology can be taken to scale. It uses the Zimbabwe experience and highlights some of the benefits in the application of PHAST, conditions necessary for scaling up and possible constraints. The PHAST initiative started off as a pilot process seeking to promote improved hygiene behaviour and promotion of sanitation. Having successfully piloted PHAST, Zimbabwe has scaled up the use of the methodology at a country level. While impact studies have not yet been conducted, reviews of the effects of the process have indicated positive behaviour change in such areas as management of water, construction and use of latrines. The process has also led to a change of institutional approaches in planning for improved water and sanitation from supply driven projects to demand responsive approaches. Some lessons learnt have included the need for baseline surveys at the start of the use of PHAST, the difficulty in developing monitoring indicators and hence difficulty in measuring impacts. Conclusions being drawn using assessment studies are that the use of participatory approaches has led to improved hygiene behaviour with communities being able to link causes and effects. The use of participatory methods also necessitates a change in institutional approaches from supply driven approaches to demand responsiveness. Other lessons drawn were related to the creation of an enabling environment for the application of participatory processes. Such enabling environment includes capacity building, resource allocation, policy and institutional support.
Community Participation↗
Achievement of the World Bank loan project on schistosomiasis control (1992-2000) in Hubei province and the challenge in the future.
Since the World Bank provided a loan for control of schistosomiasis in China, started from 1992, with the objective of a reduction of prevalence and intensity of the infection both in humans and animals by 40%, through mass chemotherapy in areas of high prevalence, and selective chemotherapy in areas with medium and low endemicity together with focal mollusciciding, the objective of morbidity control of the project has been reached in Hubei Province.
Animals↗
An Italian approach to postmarketing monitoring: preliminary results from the SCOLTA (Surveillance Cohort Long-Term Toxicity Antiretrovirals) project on the safety of lopinavir/ritonavir.
The SCOLTA project (Surveillance Cohort Long-term Toxicity Antiretrovirals) is a system for online surveying of adverse reactions to recently commercialized antiretroviral drugs and a "sentinel" for unexpected and late adverse reactions arising during any antiretroviral treatment (available at: http://www.cisai.info). To date, 25 Italian departments of infectious diseases have participated at the project. The New Drugs Project is a prospective, multicenter, observational pharmacovigilance study involving 1 cohort of patients for each new drug. All patients who were consecutively started on lopinavir (LPV), tenofovir (TDF), peginterferon (IFN), atazanavir (ATZ), enfuvirtide (T-20), and tipranavir (TPV) were enrolled. All grade III or IV adverse events (according to the AIDS Clinical Trials Group definitions) are reported on the web site. The Unexpected Events Project identifies unexpected adverse reactions during treatment and reports them. This paper presents the preliminary findings for the New Drugs Project. Between October 1, 2002, and March 30, 2004, 1184 patients were enrolled. The lopinavir/ritonavir (LPV/r) cohort comprises 703 patients, the TDF cohort 585, IFN 35, ATZ 95, T-20 10, and TPV 8. So far 100 grades III and IV adverse events have been reported, 73 in the LPV/r group. In this cohort the rate of adverse events per 100 person-years was 14.2 on the basis of all patients treated, 9.8 for treatment-naive patients, and 15 for treatment-experienced patients. These findings, though preliminary, show that this data collection method gives timely real-life information from which to assess the impact of short- and long-term toxicity of new antiretroviral drugs.
Adult↗
Structure of a conserved hypothetical protein, TTHA0849 from Thermus thermophilus HB8, at 2.4 A resolution: a putative member of the StAR-related lipid-transfer (START) domain superfamily.
The crystal structure of a conserved hypothetical protein, TTHA0849 from Thermus thermophilus HB8, has been determined at 2.4 A resolution as a part of a structural and functional genomics project on T. thermophilus HB8. The main-chain folding shows a compact alpha+beta motif, forming a hydrophobic cavity in the molecule. A structural similarity search reveals that it resembles those steroidogenic acute regulatory proteins that contain the lipid-transfer (START) domain, even though TTHA0849 shows comparatively weak sequence identity to polyketide cyclases. However, the size of the ligand-binding cavity is distinctly smaller than other START domain-containing proteins, suggesting that it catalyses the transfer of smaller ligand molecules.
Crystallography, X-Ray↗
Impact of first-responder defibrillation in an urban emergency medical services system.
OBJECTIVE: To evaluate the impact of adding first-responder defibrillation by fire-fighters to an existing advanced life-support emergency medical services system. DESIGN: Nonrandomized, controlled clinical trial with periodic crossover. SETTING: Memphis, Tenn, a city of 610,337 people, which is served by a fire department-based emergency medical services system. All city ambulances provide advanced life support. PATIENTS: Adult victims of out-of-hospital cardiac arrest due to heart disease. INTERVENTION: Twenty of 40 participating engine companies were equipped with an automated external defibrillator and ordered to apply it immediately in all cases of cardiac arrest. The other 20 companies were ordered to start cardiopulmonary resuscitation (CPR) immediately and wait for paramedics to arrive. Every 75 days, group roles were reversed. Care otherwise proceeded according to 1986 American Heart Association guidelines. MAIN OUTCOME MEASURES: Return of spontaneous circulation in the field, survival to hospital admission, survival to hospital discharge, and neurological status at discharge. RESULTS: During the 39-month study interval, 879 patients were treated by a project engine company. Four hundred thirty-one (49%) of these were found in ventricular fibrillation. Bystander CPR was started in only 12% of cases. Overall, firefighters reached the scene a mean of 2.5 minutes faster than simultaneously dispatched paramedics. Although our automated external defibrillators proved to be reliable and efficacious for terminating ventricular fibrillation and pulseless ventricular tachycardia, patients treated by an automated external defibrillator-equipped engine company were no more likely than CPR-treated controls to be resuscitated (32% vs 34%, respectively), to survive to hospital admission (31% vs 29%), or to survive to hospital discharge (14% vs 10%). Neurological outcomes were also similar in the two treatment groups. CONCLUSIONS: In a fast-response, urban emergency medical services system served by paramedics, the impact of adding first-responder defibrillation appears to be small. Early defibrillation alone cannot overcome low community rates of bystander CPR. Careful attention to every link in the "chain of survival" is needed to achieve optimal rates of survival after cardiac arrest.
Aged↗
Eight-year follow-up results of an adolescent smoking prevention program: the North Karelia Youth Project.
In the North Karelia Youth Program five to 10 classroom sessions over two years taught skills to resist pressures to start smoking to 13 to 15 year old students. Compared to students from comparison schools, the treatment groups reported less smoking immediately after the intervention and in a four-year follow-up survey. At the eight-year follow-up, there was consistent evidence of possible preventive effects only among those who had been non-smokers when the program began.
Adolescent↗
Projection of lung cancer mortality in Japan.
According to the National Vital Statistics data, age-standardized mortality rates (ASRs) of lung cancer have shown slightly declining trends in Japan for both men and women. In order to evaluate whether this tendency will continue, a Bayesian age-period-cohort (APC) model was applied using the National Vital Statistics data from 1952 to 2001. In the projection, a Gaussian autoregressive prior model was applied to smooth age, period, and cohort effects from its 2 immediate predecessors by extrapolation. Posterior distributions from which we drew inferences on mortality rates were derived from 15,000 iterations using 5000 burn-in iterations. We defined the median of the iterated values as the overall summary mortality rate of the iterated results. Our results suggest that the number of deaths due to lung cancer will double for men and women during the next 3 decades due to the aging of the baby-boomer generation (individuals who were born between 1947 and 1951). Currently declining trends in some age groups will reverse and start to increase again in the next decades. However, for recent birth cohorts, the results of the projection varied according to whether the data set included early age group mortality or not. Lung cancer mortality in the future depends on the risk factors engaged in by today's young people, especially smoking. Strong promotion of anti-smoking measures and careful surveillance for lung cancer are needed.
Adult↗
Estimation and projections of cancer prevalence from cancer registry data.
A method, PIAMOD (Prevalence, Incidence, Analysis MODel), which allows the estimation and projection of cancer prevalence patterns by using cancer registry incidence and survival data is presented. As a first step the method involves the fit of incidence data by an age, period and cohort model to derive incidence projections. Prevalence is then estimated from modelled incidence and survival estimates. Cancer mortality is derived as a third step from modelled incidence, prevalence and survival. An application to female breast cancer is given for the Connecticut State by using data from the Connecticut Tumor Registry (CTR), 1973-1993. The age, period and cohort model fitted incidence quite well and allowed us to derive long-term projections up to 2030. Patients' survival was also projected to future years according to a scenario approach based on two extreme hypotheses: steady, that is, no more improvements after 1993 (conservative), and continuously improving at the same rate as during the observation period. Age-standardized estimated incidence shows a changing trend around the year 2005, when it starts decreasing. Age-standardized prevalence is expected to increase and change trend at a later date. Breast cancer mortality is projected as decreasing, as the combined result of no further increase in incidence and improving cancer patients' survival. An easy-to-use PIAMOD software package, on which work is in progress, will be made available to individual cancer registries and/or health planning institutions or authorities once it is developed. The use of the PIAMOD method for cancer registries will allow them to provide results of paramount importance for the whole community involved in the assessment of future disease burden scenarios in an evolving society.
Adult↗
[Combined vocational education and industrial management--presentation of a cooperative project for improved integration of adolescents with learning handicaps].
Major structural labour market changes, i.e. dramatic losses in job opportunities for unskilled labour and continually rising levels of job requirements facing skilled workers on the one hand and an increasing demand for skilled workers on the other, are entailing enhanced job opportunities for disadvantaged societal groups, at the same time however also increasing the occupational risk of these populations, among them the learning disabled. The vocational training centres having for more than a decade been gaining experience in the vocational and social rehabilitation of this latter group, the project outlined is intended to make even better use of their potential. The main objectives of the project are: 1. optimizing the vocational training centres' range of placement-focussed measures by: intensifying industrial training periods, coordinated "start up" support on occupational entry, post-placement services; 2. transfer of the vocational training centres' technical knowledge and experience into industry-based training by: follow-along support services ("ausbildungsbegleitende Hilfen"), workshops on the initial vocational training of learning disabled young adults, and other forms of cooperation. Apart from reaching the goals outlined, the project is expected to give new impulse to the day-to-day practice of the vocational training centres as well as to generate even greater networking of the centres with their industrial environments.
Adolescent↗
Role of nitric oxide in the development of retinal projections.
Synthesis of nitric oxide (NO) occurs downstream from activation of NMDA receptors and NO acts as a retrograde messenger, influencing the refinement and stabilization of coactive afferent terminals. Cells and neuropil in the rat superior colliculus (SC) and lateral geniculate body (LGB) show intense, developmentally regulated activity for NO synthase (NOS). To study the role of NO in the development of retinogeniculate and retinotectal axon arbors, we examined primary visual projections of rats that had received daily i.p. injections of L-NoArg (an NOS inhibitor) for 4-6 weeks starting from postnatal day 0. Retinal fibers labeled by intraocular injection of the B subunit of cholera toxin were revealed immunohistochemically and the density of fibers in the superficial SC and in the dorsal LGB was measured by computerized image analysis. Single retinocollicular terminal arbors were reconstructed at the computer (Neurolucida). Treated rats showed significant alterations in ipsilateral retinotectal projections, in the mediolateral and anteroposterior axes: there was an increase in the density of fibers entering the SC, in branch length, and in numbers of boutons on retinotectal arbors in the treated group. Ipsilaterally projecting retinal axons also showed an increase in density and distribution in the dorsal nucleus of the LGB. If animals were allowed to survive for several months after stopping treatment, similar changes were also noted, but these were much less striking. Our results suggest that, in the mammalian visual system, NO released from target neurons in the SC and LGB serves as a retrograde signal which feeds back on retinal afferents, influencing their growth.
Aging↗
Structure of the upper teeth of the filefish, Stephanolepis cirrhifer.
The teeth of the filefish were investigated with light and scanning electron microscopy. Anterior and posterior rows of pleurodont teeth are present in the maxilla. The teeth in the anterior row possess a large labial and small lingual surface and the teeth in the posterior row possess a small labial and large lingual surface. The enameloid consists of three layers-the outer, middle, and inner layer. The outer layer consists of fine, parallel crystallites oriented perpendicular to the surface. They are similar to the crystallites in enamel derived from ectoderm. In the middle layer the crystallites form parallel bundles that are oriented in the same direction as that of the crystallites in the outer layer. In the inner layer bundles of crystallites interlace with each other. The tubular structures and the terminal branches of the dentinal tubules are located among the crystallites in the inner layer. In the dentine numerous dentinal tubules radiate from the pulp cavity toward the periphery and are seen to curve slightly in an S-shaped course. At the occlusal tip the alternating parabolic layers are seen and these are considered to be mineralized lines. The openings of the dentinal tubules are round or oval, surrounded by interlacing fibrils. The teeth are tightly fixed to the jawbone by bundles of fibrils. At the lower part of the lingual surface of the teeth in the anterior row and the labial surface of the teeth in the posterior row the bundles of fibrils start at the dentine and some fibrils run through connective tissue, while others terminate in projections of the jawbones.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Volume estimation of biological objects by systematic sections.
The absolute volume of biological objects is often estimated stereologically from an exhaustive set of systematic sections. The usual volume estimator V is the sum of the section contents times the distance between sections. For systematic sectioning with a random start, it has been recently shown that V is unbiased when m, the ratio between projected object length and section distance, is an integer number (Cruz-Orive 1985). As this quantity is no integer in the real world, we have explored the properties of V in the general and realistic situation m epsilon R. The unbiasedness of V under appropriate sampling conditions is demonstrated for the arbitrary compact set in 3 dimensions by a rigorous proof. Exploration of further properties of V for the general triaxial ellipsoid leads to a new class of non-elementary real functions with common formal structure which we denote as np-functions. The relative mean square error (CE2) of V in ellipsoids is an oscillating differentiable np-function, which reduces to the known result CE2 = 1/(5m4) for integer m. As a biological example the absolute volumes of 10 left cardiac ventricles and their internal cavities were estimated from systematic sections. Monte Carlo simulation of replicated systematic sectioning is shown to be improved by using m epsilon R instead of m epsilon N. In agreement with the geometric model of ellipsoids with some added shape irregularities, mean empirical CE was proportional to m-1.36 and m-1.73 in the cardiac ventricle and its cavity. The considerable variance reduction by systematic sectioning is shown to be a geometric realization of the principle of antithetic variates.
Animals↗
Crystallographic modelling.
The project on crystallographic modelling aims at extending the application of interactive graphics to inorganic structures. Starting from the available expertise in organic and protein modelling, the symmetry of the crystal structure is used not only to draw fixed models of many unit cells of the structure, which as an entity can be interactively manipulated, but also to change details of the structures interactively with retention of the original symmetry. Real-time shifts of atom positions are automatically applied to all symmetry-equivalent atoms given the symmetry constraints. This also applies to translations and rotations of groups of atoms. In order to get feedback about these structural changes one can simulate powder diffraction patterns in real-time mode and compare them with the experimental powder patterns. These features are crucial in truly crystallographic modelling, but have not been implemented before in other programs. The program can be used in combination with standard molecular modelling programs and is also interfaced to the Inorganic Crystal Structure Database. Before describing the realization of these features on state-of-the-art hardware, we will review the expertise in molecular modelling and discuss an MS-DOS program to study inorganic crystal structures.
Computer Graphics↗