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At least 1,423 records · Page 79Linked to original sources
PubMed1999

Proton beam therapy for age-related macular degeneration: development of a standard plan.

Age-related macular degeneration is the leading cause of blindness in developing countries. Irradiating the exudative form, in which a choroidal neovascular membrane develops in the subfoveal area, is presently a treatment under investigation. In 1995, Massachusetts General Hospital, collaborating with Massachusetts Eye and Ear Infirmary, initiated a protocol to treat SCNV membranes using the proton beam at the Harvard Cyclotron Laboratory and the EYEPLAN program with a light-field setup. EYEPLAN requires the axial eye length, membrane dimensions, and manipulation of the eye to include a 4.0-mm radial margin around the membrane so that the aperture margin (50% isodose line on the posterior retina) abuts the inferior aspect of the limbus. Review of 100 individually prepared plans showed that 95% of the fabricated apertures were circular (aspect ratio < 1.095) with diameters 9.5 to 15.0 mm. This information was used to develop an automated standard plan. Thirty-nine plans were developed for axial lengths ranging from 21.0 to 25.0 mm and membrane sizes from 1.5 to 6.75 mm in the usual way as the reviewed ones. Circular targets were outlined centered on the fovea. Distal and proximal 90% ranges (modulation) to the target, and doses to macula, optic disc, lens, ciliary body, retina, and globe were calculated. An automated standard plan requiring the same input data, but avoiding the need for individual plans, was developed. The program outputs the aperture diameter, fixation angle for the light-field setup, range and modulation, and calculates dose to the macula and optic nerve and percentage of retina receiving > or = 50% and > or = 90% of the prescribed dose. Individual plans require approximately 1.5 hours; the standard plan, 5 minutes. The standard plan could have treated 86% of the reviewed plans. The automated plan provides accurate and efficient treatment parameters for the majority of patients.

Fluorescein Angiography↗
PubMed1999

A study to test the effectiveness of placebo Reiki standardization procedures developed for a planned Reiki efficacy study.

Reiki is one type of alternative therapy that is increasing in popularity. It is advocated by its practitioners as a precise method for connecting universal life energy with the body's innate process of healing through hands-on techniques. The claim of Reiki practitioners is that Reiki reduces a variety of physical problems and improves psychospiritual well-being. There are abundant anecdotal records that support the previous claim, and a few pioneer scientific studies are starting to emerge. Although the Reiki research in totality supports the anecdotal records, the absence of randomized and placebo-controlled trials precludes the interpretation of the outcomes as resulting from specific effects as opposed to placebo effects plus natural history. Authorities in the field indicate that researchers interested in placebo-controlled studies should have the placebo treatment look exactly like the real intervention in every respect. Because no studies could be found in the literature that tested standardization procedures for real and placebo Reiki, the decision was made to conduct one. The purpose of this study was to test the standardization procedures developed by our research team for placebo Reiki, before going ahead and conducting our planned full-scale randomized and placebo-controlled Reiki efficacy study. This study used a 4-round, crossover experimental design in which 20 blinded subjects (12 students, 4 breast cancer survivors, and 4 observers) were exposed to a combination of 2 interventions (Reiki plus Reiki, or placebo plus placebo, or Reiki plus placebo, or placebo plus Reiki); and were then asked to evaluate the interventions using a self-administered questionnaire. The blinded observers were used in round number 4. Two real Reiki practitioners in the Usui system were chosen first, then 2 placebo practitioners who closely resembled them were recruited. The placebo practitioners were trained in Reiki by the study Reiki Master and the principal investigator, but were not initiated. The belief in Reiki is that only practitioners that are initiated could give Reiki, thus making it possible to have a placebo arm in efficacy studies. The findings of the study indicate that the developed standardization procedures were successful because none of the final participants in round 4 (4 breast cancer patients and 4 observers) could differentiate between the identity of placebo and Reiki practitioners. The qualitative comments expressed by the participants further con-firmed the quantitative data. It was concluded based on these findings that it is safe to go ahead and conduct the planned randomized 3-arm Reiki efficacy clinical trial. It is recommended that scholars interested in Reiki research could incorporate our techniques to strengthen their designs by adding a placebo arm.

Acupressure↗
PubMed1980

Developing an emergency medical disaster plan for an airport.

The development of the Emergency Medical Disaster Plan for Minneapolis-St. Paul International Airport as a model for other major hub airports is discussed. Conformance with federal regulations and the need to closely coordinate activities with both on-airport personnel and off-airport facilities are considered and incorporated into the plan. Manpower sources are reviewed and methods are developed for the efficient handling and treatment of disaster victims. Essential services for an emergency are categorized and their responsibilities designated. Centers of control for support personnel and vehicles are established. Consideration is also given to the special requirements of friends and relatives of the victims and of the news media. Conducting disaster drills as a means to evaluate and improve the basis plan is also examined.

Aircraft↗
PubMed2007

Evidence of early development of action planning in the human foetus: a kinematic study.

The aim of the present study was to investigate whether foetal hand movements are planned and how they are executed. We performed a kinematic analysis of hand movements directed towards the mouth and the eyes in the foetuses of eight women with normally evolving pregnancies. At 14, 18 and 22 weeks of gestation, eight foetuses underwent a 20-min four-dimensional-ultrasound session. The video recordings for these movements were then imported into in-house software developed to perform kinematic analysis. We found that spatial and temporal characteristics of foetal movements are by no means uncoordinated or unpatterned. By 22 weeks of gestation the movements seem to show the recognizable form of intentional actions, with kinematic patterns that depend on the goal of the action, suggesting a surprisingly advanced level of motor planning.

Adult↗
PubMed1987

Four systems develop regionally organized HMO.

Plans to establish HealthPlus HMO, Inc.--a joint venture of the Sisters of St. Francis Health Services, Ancilla Systems, Daughters of Charity Health Systems-East Central, and Holy Cross Health System--began in 1984 with a feasibility study to assess the potential for an HMO in Indiana. Goals set by the four systems included protecting and expanding hospitals' market share and physicians' patient bases; establishing local HMO ownership; and providing health education, preventive care, and comprehensive treatment at affordable costs. During the organizational phase, participants created a 12-member board of directors with three representatives from each system, selected the name HealthPlus, and contracted with a management company to direct the HMO's planning and development phases. HealthPlus adopted a regional organizational structure, which allows financial risk to be shared among three regions, and a primary care physician model for the delivery of services. As of January 1987, the joint venture had 16 participating hospitals, 345 primary care physicians, more than 1,000 consulting specialists, and a membership of 13,100. HealthPlus now offers a triple-option product in partnership with a preferred provider organization and an insurance carrier and has developed non-health-related products with the insurance carrier as well.

Catholicism↗
PubMed1997

Peripheral development of cranial nerves in a cyclostome, Lampetra japonica: morphological distribution of nerve branches and the vertebrate body plan.

The development of peripheral nerves was studied in a Japanese marine lamprey, Lampetra japonica, in whole-mount and sectioned embryos from hatching until the earliest ammocoete. Nerve fibers were immunohistochemically stained with a monoclonal antibody against acetylated tubulin. Branchiomeric nerves first developed in a simple metamerical pattern, each associated with a single pharyngeal arch. Of those, the ophthalmicus profundus, maxillomandibular, and facial nerves later developed a highly modified branching pattern, whereas postotic nerves were less specialized and showed the stereotypical branching pattern of post-trematic nerves. The early distribution of melanocytes in myotome-free space largely overlapped with the morphology of the cranial nerve and ganglion anlage, and resembled the cephalic crest cell distribution pattern in the early chick embryo. It was suggested that the cephalic crest cell distribution, which is also inhibited by myotomes in the lamprey, would be the common basis for branchiomeric nerve patterning. In later development of the lamprey embryo, myotomes 1 through 3, which had originated in the postotic region, grew rostrally into the preotic region, laterally covering all of the branchiomeric nerves. This results in a deep position of the cranial nerves, which is not observed in gnathostomes.

Animals↗
PubMed2005

Science, policy, and stakeholders: developing a consensus science plan for Amchitka Island, Aleutians, Alaska.

With the ending of the Cold War, the US Department of Energy is responsible for the remediation of radioactive waste and disposal of land no longer needed for nuclear material production or related national security missions. The task of characterizing the hazards and risks from radionuclides is necessary for assuring the protection of health of humans and the environment. This is a particularly daunting task for those sites that had underground testing of nuclear weapons, where the radioactive contamination is currently inaccessible. Herein we report on the development of a Science Plan to characterize the physical and biological marine environment around Amchitka Island in the Aleutian chain of Alaska, where three underground nuclear tests were conducted (1965-1971). Information on the ecology, geology, and current radionuclide levels in biota, water, and sediment is necessary for evaluating possible current contamination and to serve as a baseline for developing a plan to ensure human and ecosystem health in perpetuity. Other information required includes identifying the location of the salt water/fresh water interface where migration to the ocean might occur in the future and determining groundwater recharge balances, as well as assessing other physical/geological features of Amchitka near the test sites. The Science Plan is needed to address the confusing and conflicting information available to the public about radionuclide risks from underground nuclear blasts in the late 1960s and early 1970s, as well as the potential for volcanic or seismic activity to disrupt shot cavities or accelerate migration of radionuclides into the sea. Developing a Science Plan involved agreement among regulators and other stakeholders, assignment of the task to the Consortium for Risk Evaluation with Stakeholder Participation, and development of a consensus Science Plan that dealt with contentious scientific issues. Involvement of the regulators (State of Alaska), resource trustees (U S Fish and Wildlife Service), representatives of the Aleut and Pribilof Island communities, and other stakeholders was essential for plan development and approval, although this created tensions because of the different objectives of each group. The complicated process of developing a Science Plan involved iterations and interactions with multiple agencies and organizations, scientists in several disciplines, regulators, and the participation of Aleut people in their home communities, as well as the general public. The importance of including all parties in all phases of the development of the Science Plan was critical to its acceptance by a broad range of regulators, agencies, resource trustees, Aleutian/Pribilof communities, and other stakeholders.

Alaska↗
PubMed1994

Customer service, access and capacity: vital signs for developing a marketing plan.

Marketing plans that do not include an analysis of customer service, access and capacity issues are incomplete documents. Unresolved customer service, access and capacity issues can undermine an otherwise well-designed marketing plan. The medical and administrative leadership of the group practice or clinical department must work together to identify customer service, access and capacity issues which are affecting the practice's ability to respond to the needs of the marketplace. Someone with marketing expertise can provide valuable input to this process. The resulting solutions need to be developed which are realistic and in keeping with the general marketing direction of the practice.

Appointments and Schedules↗
PubMed2000

Planning factors for developing an enterprise-wide picture archiving and communication system maintenance program.

Picture archiving and communication system (PACS) maintenance on an individual site basis has historically been a complex and costly challenge. With the advent of enterprise-wide PACS projects such as the Virtual Radiology Environment (VRE) project, the challenge of a maintenance program with even more complexities has presented itself. The approach of the project management team for the VRE project is not one of reactive maintenance, but one of highly proactive planning and negotiations, in hopes of capitalizing on the economies of scale of an enterprise-wide PACS maintenance program. A proactive maintenance program is one aspect of life-cycle management. As with any capital acquisition, life-cycle management may be used to manage the specific project aspects related to PACS. The purpose of an enterprise-wide warranty and maintenance life-cycle management approach is to maintain PACS at its maximum operational efficiency and utilization levels through a flexible, shared, yet symbiotic relationship between local, regional, and vendor resources. These goals include providing maximum operational performance levels on a local, regional, and enterprise basis, while maintaining acceptable costs and resource utilization levels. This goal must be achieved without negatively impacting point of care activities, regardless of changes to the clinical business environment.

Cost-Benefit Analysis↗
PubMed2006

An efficient numerical technique for bioheat simulations and its application to computerized cryosurgery planning.

As a part of ongoing efforts to develop computerized planning tools for cryosurgery, the current study focuses on developing an efficient numerical technique for bioheat transfer simulations. Our long-term goal is to develop a planning tool for cryosurgery that takes a 3D reconstruction of a target region, and suggests the best cryoprobe layout. Toward that goal, a planning algorithm, termed "force-field analogy," has been recently presented, based on a sequence of bioheat transfer simulations, which are by far the most computationally expensive part of the planning method. The objective in the current study is to develop a finite difference numerical scheme for bioheat transfer simulations, which reduces the overall run time of computerized planning, thereby making it clinically relevant. While the general concept of variable grid size and time intervals is not new, its application to the phase change problem of cryosurgery is the unique contribution of the current study.

Computer Simulation↗
PubMed2000

Cortical development and saccade planning: the ontogeny of the spike potential.

The spike potential is a sharply timed positivity which precedes eye movements in adults, and is thought to indicate cortical planning of saccades. While the spike potential is observed under most conditions in adults, it has not been reported in young infants. In the present study we shed light on the ontogeny of the spike potential by demonstrating for the first time its existence in a group of older infants (12 months). This result is consistent with a relatively delayed onset of cortical control over saccades during development.

Age Factors↗
PubMedDate not supplied

Maintaining family planning acceptance levels through development incentives in Northeastern Thailand.

The results of a two-year longitudinal study of the effect that development program incentives have upon family planning in Northeastern Thailand are presented. These incentives, implemented by the Population and Community Development Association, Thailand, included animal raising and agricultural, home industry, and environmental activities. An experimental design including baseline and follow-up surveys supplemented by a continuous monitoring system was utilized to test hypotheses on the family planning impacts of the incentives. Findings indicate that the incentives contributed significantly to the maintenance of high levels of family planning practice through the program period 1982-1984.

Contraception Behavior↗