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At least 163 records · Page 9Linked to original sources
PubMed2006

Harmony hurts: participation and silent conflict at an Indonesian fish pond.

Participatory environmental and resource management is premised on open communication to reach consensus. However, deliberate and open communication cannot adequately address silent conflict. This begs two questions. First, how is the existence of covert communication and silent conflict to be recognized and addressed? Second, how are the wider social relations and traditions that encompass communication and conflict to be described and explained? These questions revolve around communicative power. Communication of environmental knowledge is deeply embedded in social power structures, with direct implications for participatory resource planning and implementation. Ethnographic research conducted at a failed community-managed fish farming project in Southeast Sulawesi, Indonesia shows that a culture of harmony and respect for authority can silence environmental conflict in the hierarchical "community." Three propositions are offered. First, communication amnesia and exclusion jeopardize participation. Second, cultures of harmony and silent conflict shape planning processes and outcomes. Third, the weak use manipulation and communication strategy to acquire a "voice" while preserving harmony. These propositions address five unresolved issues in participatory resource management: analysis of groups, contextuality, social relationships, nonparticipants, and informal communication. Power, tradition, and social networks affect the valuing of knowledge relative to the power of different individuals and institutions to communicate priorities, values, and needs. These factors are critical to the inclusion of both participants and nonparticipants.

Adolescent↗
PubMed1998

The Information Commons: a model for (physical) digital resource centers.

Since its planning, construction, and opening in 1996, the Information Commons, located in The University of Iowa's Hardin Library for the Health Sciences, has served as a common ground for self-directed learning, information research, hands-on class sessions, and multimedia development. Initiatives launched from the Information Commons not only have helped increase the visibility of Hardin Library as an environment well equipped to support traditional research and education needs, but have promoted the library as a campus leader and viable partner in planning and delivering digital technologies effectively. Ongoing initiatives have focused on better integrating the library's services and resources with the curricula and research needs of the university's health sciences units. This paper describes the facility, its programmatic elements, and its impact on education, communication, and technology trends in an academic health sciences setting. Particular attention is paid to initiatives launched during the first two years of operation. This paper also discusses plans for expansion of the facility.

Budgets↗
PubMed2005

Physicians' responses to resource constraints.

BACKGROUND: A common dilemma that confronts physicians in clinical practice is the allocation of scarce resources. Yet the strategies used by physicians in actual situations of resource constraint have not been studied. This study explores the strategies and rationales reported by physicians in situations of resource constraints encountered in practice. METHODS: A national survey of US internists, oncologists, and intensive care specialists was performed by computer-assisted telephone interviews. As part of this survey, we asked physicians to tell us about a recent ethical dilemma encountered in practice. A subset of respondents reported difficulties regarding resource allocation. Transcripts of open-ended responses were coded for content based on consensus. RESULTS: Of the 600 physicians originally identified, 537 were eligible and 344 participated (response rate, 64%). Internists do not make allocation decisions alone but rather engage in negotiation in their resolution. Furthermore, these decisions are not made as dichotomous choices. Rather they often involve alternative solutions in the face of complexities of both the health care system and situations where limited resources must be allocated. Justice is not commonly the justification for rationing. CONCLUSION: Physicians' experiences in situations of resource constraints appear to be more complex than the normative literature on health care rationing assumes. In addition, reasoning about justice in health care seems to play only a small part in clinical decision making. Bridging this gap could be an important step in fostering fair allocation of resources in difficult cases.

Adult↗
PubMed2024

Haplotype-resolved genome assembly and implementation of VitExpress, an open interactive transcriptomic platform for grapevine.

Haplotype-resolved genome assemblies were produced for Chasselas and Ugni Blanc, two heterozygous Vitis vinifera cultivars by combining high-fidelity long-read sequencing and high-throughput chromosome conformation capture (Hi-C). The telomere-to-telomere full coverage of the chromosomes allowed us to assemble separately the two haplo-genomes of both cultivars and revealed structural variations between the two haplotypes of a given cultivar. The deletions/insertions, inversions, translocations, and duplications provide insight into the evolutionary history and parental relationship among grape varieties. Integration of de novo single long-read sequencing of full-length transcript isoforms (Iso-Seq) yielded a highly improved genome annotation. Given its higher contiguity, and the robustness of the IsoSeq-based annotation, the Chasselas assembly meets the standard to become the annotated reference genome for V. vinifera. Building on these resources, we developed VitExpress, an open interactive transcriptomic platform, that provides a genome browser and integrated web tools for expression profiling, and a set of statistical tools (StatTools) for the identification of highly correlated genes. Implementation of the correlation finder tool for MybA1, a major regulator of the anthocyanin pathway, identified candidate genes associated with anthocyanin metabolism, whose expression patterns were experimentally validated as discriminating between black and white grapes. These resources and innovative tools for mining genome-related data are anticipated to foster advances in several areas of grapevine research.

Vitis↗
PubMed1998

[Organization and results of ambulatory surgery for inguinal hernia].

The results of a reorganization of surgery for inguinal hernias within a department of surgical gastroenterology were assessed concerning staff simplifications, feasibility, patient satisfaction, safety, complications and resources. Five hundred consecutive, elective, open operations for unilateral reducible inguinal hernias were performed in 466 patients under local anaesthesia in an ambulatory setup. One hundred and fourteen of the operations were for a recurrent hernia. The median age was 60 years (44-74 years as 25% and 75% quartiles). Two of the operations were converted to general anaesthesia. The patients were discharged 85 min (median) post-operatively, but 12 patients were not discharged on the same day. Bleeding or wound infections in need of treatment were seen postoperatively in 1.6% and 1.6%, respectively. All patients were given a postoperative questionnaires with a response rate of 95%, 89% of the respondents were satisfied with the whole procedure, 11% were dissatisfied. A reorganization of surgery for inguinal hernias to a standardized ambulatory setup induced staff simplifications and saved resources with a preserved high patient satisfaction, safety and a low complication rate.

Adolescent↗
PubMed1982

Measuring the benefits of screening for open neural tube defects.

Evaluation of the costs and benefits of public sector programmes is necessary to plan the optimum uses for society's resources. Here the benefits of screening for open neural tube defects are examined, and the most appropriate methodological approach to their valuation is discussed in the context of the possible provision by the National Health Service of a routine prenatal screening programme. It is argued that, in measuring the benefits of screening, previous evaluations have adopted an approach that is rather unsatisfactory from the standpoint of economic methodology. An attempt is therefore made here to show the effect that adopting a more appropriate approach would have on the estimated value of the benefit of routine screening. The effect is found to be a substantial increase in its estimated value.

Cost-Benefit Analysis↗
PubMed2005

Whole genome SNP arrays using DNA derived from formalin-fixed, paraffin-embedded ovarian tumor tissue.

Array-based genotyping platforms, such as the Affymetrix mapping array, have been validated as reliable methods for obtaining high-resolution copy number and allele status information when using DNA derived from fresh tissue sources. However, the suitability of such systems for the examination of DNA derived from formalin-fixed, paraffin-embedded (FFPE) tissues has not been tested. Therefore, we analyzed DNA derived from five matching fresh frozen and FFPE ovarian tumors for gene copy number changes and loss of heterozygosity using the Affymetrix GeneChip Human Mapping 10 K Array Xba 131. The data was analyzed using Affymetrix proprietary software, GeneChip DNA Analysis Software, and Chromosome Copy Number Tool. The average SNP call rate (rate of successful genotype identification) of the fresh samples was 89.44% (range 78.72-96.22%, median 92.72%) and was only slightly lower for the matching FFPE samples at 83.48% (range 76.93-93.17%, median 82.60%). The average concordance (rate of agreement between successful genotype calls) between the fresh and matching FFPE samples was 97.06% (range 92.70-99.41%, median 97.52%). Loss of heterozygosity (LOH) profiles of the fresh and FFPE samples were essentially identical across all chromosomes. Copy number data was also comparable, although the quantification of copy number changes appears overstated in the FFPE samples. In conclusion, we have shown that it is possible to achieve high-performance outcomes using FFPE-derived DNA in the Affymetrix 10 K mapping array. This advance will open up vast archival tissue resources to high-resolution genetic analysis and unlock a wealth of biological information.

DNA↗
PubMed2006

Civilising missions, natural history and British industry: Livingstone in the Zambezi.

High hopes for opening new markets, locating natural resources and the 'advance of civilisation' were built into the plans for Victorian expeditions to Africa. When an expedition failed to deliver on these goals, criticisms of individual explorers and the entire 'civilising mission' project could result. The Zambesi Expedition, led by David Livingstone, received just such criticism when politics and geography obstructed the realisation of its aims. The needs of a growing industrial sector contributed to the organisation of the Expedition but also set the criteria by which its success or failure would be judged.

Africa↗
PubMed2000

Sexual abuse during childhood and adolescence among Nicaraguan men and women: a population-based anonymous survey.

AIMS: The objective was to describe experiences of sexual abuse occurring before 19 years of age among men and women in León, Nicaragua and to explore the possible association to later sexual risk behavior. METHOD: A sub-sample of literate urban men and women 25-44 years of age was selected from a representative sample of households in León. After an invitation to a public health event, 154 men (53% of the invited) and 213 women (66% of those invited) participated in giving written answers to an anonymous questionnaire. RESULTS: Twenty percent of men and 26% of women reported that they had experienced sexual abuse. Women had been victims of attempted or completed rape twice as often as men, 15% as compared to 7%. Thirty-three percent of the abuse towards boys and 66% of the abuse towards girls was committed by family members. Women who had experienced attempted or completed rape were more likely to later have had a higher number of sexual partners compared to non-abused or moderately abused women. CONCLUSIONS: Sexual abuse of children and adolescents of both sexes is common in Nicaragua. The results underscore the urgent need to address this serious problem more openly, and to make more resources available for the prevention of sexual abuse and for support to victims.

Adolescent↗
PubMed2003

Data security issues arising from integration of wireless access into healthcare networks.

The versatility of having Ethernet speed connectivity without wires is rapidly driving adoption of wireless data networking by end users across all types of industry. Designed to be easy to configure and work among diverse platforms, wireless brings online data to mobile users. This functionality is particularly useful in modern clinical medicine. Wireless presents operators of networks containing or transmitting sensitive and confidential data with several new types of security vulnerabilities, and potentially opens previously protected core network resources to outside attack. Herein, we review the types of vulnerabilities, the tools necessary to exploit them, and strategies to thwart a successful attack.

Computer Communication Networks↗
PubMed1996

The costs and effectiveness of surveillance of communicable disease: a case study of HIV and AIDS in England and Wales.

BACKGROUND: In England and Wales, surveillance of communicable disease is carried out and co-ordinated by the Public Health Laboratory Service (PHLS). The surveillance of HIV infection and AIDS is undertaken by the PHLS AIDS Centre at the Communicable Disease Surveillance Centre (CDSC). Epidemiological data derived from surveillance are not, however, a free good: they are a resource with an associated opportunity cost and should therefore be open to economic appraisal alongside other users of health care resources such as medical interventions. This paper assembles information on the current surveillance of HIV and AIDS in England and Wales, and explores methods for performing an economic evaluation of such activities. METHODS: An examination of the cost and effectiveness of the PHLS AIDS Centre's epidemiological surveillance mechanisms for HIV and AIDS in England and Wales was undertaken. The total costs of each component of surveillance of HIV and AIDS in England and Wales were calculated. Two categories of cost were estimated: peripheral costs incurred by reporters in reporting AIDS cases or HIV infections or by laboratories in collecting samples; and central costs incurred by the PHLS AIDS Centre in processing and analysing incoming data. Using these cost data and information from a cost-effectiveness register, the additional health gains that would have to be obtained from surveillance to make the programme broadly cost-effective in comparison with other accepted uses of health service resources were then estimated. RESULTS: In the financial year 1993-1994 the total costs of surveillance were estimated to be 1.4 million pounds. To avoid being considered relatively cost-ineffective at least 3.5 infections per annum need to be averted. To be considered favourably cost-effective, approximately 9.5 infections per annum need to be averted. CONCLUSIONS: In 1993-1994, expenditure on surveillance of HIV and AIDS accounted for less than 1 per cent of the total allocation of resources to the National Health Service for all HIV and AIDS activities. Given these cost estimates, the number of infections which surveillance would have to contribute towards preventing in order to be considered cost-effective is low.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Health services research, outcomes, and perinatal information systems.

The progress in information and communication technology, together with the search for the most effective and efficient ways to use the limited resources for health care, are opening new areas for research and development in perinatal care. Information systems and practice oriented by evidence-based medicine are modifying the operation of health services, and the quality of their management is being monitored by the success of their outcomes. As a study case, a Perinatal Information System widely used in Latin America and the Caribbean is discussed in some detail. Future challenges in the compatibility of information systems and databanks, the need for longer follow-up periods and measurement of health-related quality of life as outcomes for perinatal care, and the strategies to integrate all these concepts for the improvement of daily practice are discussed.

Caribbean Region↗
PubMed2006

Improving international nurse training: an American-Italian case study.

BACKGROUND: Institutionalized international nurse training organized by national educational institutions is a relatively new phenomenon. This, descriptive case study examines an early example of an American-Italian initiative of such training, in order to stimulate future international education of nurses. AIM: To find out what factors have to be taken into account to improve training and what its potential effects are in exchange and also in the context of nurse migration. METHOD: A questionnaire was sent to the 85 nurses who all participated in this particular international programme (response rate: 30.6%). FINDINGS: The collected data indicate that personalized and well-aimed training, preparatory language courses, pre-departure exposure of nurses to the culture of the host country and well-prepared welcomes are among the most important ways to improve this programme. IMPLICATIONS FOR PRACTICE: While the specific circumstances and cultures involved in this particular case study should not be ignored, these factors might also be applied to maximize the positive effects of nurse-migration. Two-way learning is among the positive effects of such an international training experience. Motivational and team-building effects can result in enhanced quality of care and a more efficient allocation of resources. However, the mind-opening effect seems to be the most important learning experience. Therefore, regardless of whether one system is considered better or worse than another, experiencing a different way of nursing/education is considered the most important, enriching element of an international learning experience. The effects of this experience could include avoiding cultural imposition in the increased cultural diversity of nursing in the country of origin.

Attitude of Health Personnel↗
PubMed1980

[Caring for psychiatric patients in proximity to their domicile or, more than one approach may be feasible (author's transl)].

The arguments in favour of caring for psychiatric patients in locations which are close to their domicile, are by no means new. Practically all of these arguments had already been brought forward by Griesinger, and we can also read them up in the minutes of the meetings of the Federal Germany Parliamentary Committee for Youth, Family and Health Problems. A frequent argument against the decentralisation of psychiatric care by setting up psychiatric departments in general hospitals is that this would eventually lead to a kind of two-class psychiatry. In simplified language, this would imply that those patients who are acutely diseased, are admitted to a general hospital, whereas the chronically diseased persons remain in the large-scale psychiatric Land hospital. However, this is not necessarily so, if such psychiatric departments of regional competence are compulsorily allocated to a certain area, which means they are compelled to admit patients residing in their area, while being prohibited from transferring these patients to another, far-away hospital. The departments in Rheydt and Hanover, for example, show that relevant experience collected outside Germany applies likewise to the Federal Republic. In fact, the reports published by these two hospitals show that psychiatry conducted close to the domicile of the patients improves outpatient follow-up of patients with chronic disturbances, whereas the number of compulsory admissions is dramatically reduced. On the other hand, the rate of admission is increased, and the period of hospitalisation reduced. In the long run, this results in a pattern of psychiatric care in which long-term outpatient therapy predominates. We can sum up by saving that community-centered and population oriented working is by no means a panacea for all problems of psychiatric care which have remained unsolved to data. However, experience has shown that the method is feasible and, on the whole a promising one. It is precisely the return of psychiatry to the communal level which opens up non-professional resources which would otherwise remain untapped. It must be borne in mind, however, that the physician's own psychiatric practice is exposed to the public eye to greater extent than before. This offers a real chance. The psychiatrist can take advantage of this chance only if he develops a kind of sixth sense for social processes and requirements within the community, for the best way to influence them, and to make use of them for translating one's own goals into reality. Of course, this will always involve the risk of overstepping one's own area of jurisdiction, but this need not be dramatised.

Acute Disease↗
PubMed1994

The role of object representation in the design of the intelligent radiology workstation.

The paper describes the design of the Intelligent Radiology Workstation (IRW) that is intended to handle heterogeneous radiologic data (text, image, video) and radiologic knowledge in such a way that it is easy to store, access, use, and repurpose. An object-based structure is used to combine the relational database, hybrid knowledge base, and hypermedia within a common framework. Functions such as data entry and retrieval, browsing, and intelligent processing of data are available in the single environment. IRW open architecture allows radiologic digital resources to be used for clinical practice, diagnosis support, education, and research.

Artificial Intelligence↗
PubMed1995

Cost-effectiveness analysis of open reduction/nonrigid fixation and open reduction/rigid fixation to treat mandibular fractures.

OBJECTIVES: When open reduction and internal fixation is indicated for the management of mandibular fractures, it is generally agreed that nonrigid fixation and rigid fixation represent acceptable treatment alternative. Opinions vary, however, regarding the cost-effectiveness of the two alternative. The purpose of this study was to compare the costs of these treatments of mandibular fractures that required open reduction and internal fixation. STUDY DESIGN: Cost-effectiveness analysis was used to determine the most efficient resource used to treat mandibular fractures requiring open reduction and internal fixation. Cost-effectiveness was defined as the treatment charges per successfully treated patient. Data were collected retrospectively from patients with mandibular fractures treated between 1991 and 1994. The patient's medical record and hospital billing record were used as data sources. To estimate treatment charges, the sample was divided into three groups: (1) group 1, patients treated with nonrigid fixation without postoperative complications, (2) group 2, patients treated with rigid fixation without postoperative complications, and (3) group 3, patients treated with either procedure who had postoperative complications. The study variables were grouped into two categories: clinical information and charges. Treatment charges for both treatments were estimated and compared. RESULTS: Data were collected for 12 patients in group 1 and 11 patients in group 2. Costs for rigid fixation averaged $1,468 more per patient than for nonrigid fixation in uncomplicated cases. There were 11 patients in group 3. The average cost to treat a postoperative complication was $11,637. Given the institution-specific treatment cost and the probability of complications, rigid fixation was a more cost-effective treatment than nonrigid fixation. CONCLUSION: Cost estimates for treating mandibular fractures may vary widely depending on practice patterns and complication rates. Despite these cost variations, one may determine the most cost-effective treatment alternative by estimating treatment costs of both uncomplicated and complicated cases and the postoperative complication rate.

Adult↗
PubMed2004

A first version of the Caenorhabditis elegans Promoterome.

An important aspect of the development of systems biology approaches in metazoans is the characterization of expression patterns of nearly all genes predicted from genome sequences. Such "localizome" maps should provide information on where (in what cells or tissues) and when (at what stage of development or under what conditions) genes are expressed. They should also indicate in what cellular compartments the corresponding proteins are localized. Caenorhabditis elegans is particularly suited for the development of a localizome map since all its 959 adult somatic cells can be visualized by microscopy, and its cell lineage has been completely described. Here we address one of the challenges of C. elegans localizome mapping projects: that of obtaining a genome-wide resource of C. elegans promoters needed to generate transgenic animals expressing localization markers such as the green fluorescent protein (GFP). To ensure high flexibility for future uses, we utilized the newly developed MultiSite Gateway system. We generated and validated "version 1.1" of the Promoterome: a resource of approximately 6000 C. elegans promoters. These promoters can be transferred easily into various Gateway Destination vectors to drive expression of markers such as GFP, alone (promoter::GFP constructs), or in fusion with protein-encoding open reading frames available in ORFeome resources (promoter::ORF::GFP).

Animals↗