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Biomedical subjects

R L Holmes

Publications and source records attributed to R L Holmes.

At least 19 recordsLinked to original sources
PubMed2000

Objective risk adjustment improves calculated ROI for capital projects.

Most healthcare organizations can ill afford to assume risk for which they are inadequately compensated. When capital projects are being considered, factoring risk with an adjustment to the projected cost of capital can increase the calculated return on investment and improve the net present value of anticipated cash flow. This adjustment factor, however, should reflect the capital structure of the organization, historical average returns, and variance in the context of the market, the specific industry, and similar projects being considered.

Capital Financing↗
PubMed1999

Using microcomputers to improve capital decision making.

Health care organizations have traditionally selected capital projects based on subjective measures such as medical staff priority, accreditation criteria, and regulations. In some cases, basic qualitative measures, such as payback period or profitability indices, have been used. The expected reduction in available capital that will result from changes in Medicare reimbursement and from managed care, as well as increased competition, will require health care decision makers to adopt more sophisticated methods of capital project evaluation in the future if they expect their organizations to remain viable. This article demonstrates, through the use of microcomputers and commonly used spreadsheet software, that the capital selection decision process can be improved and the optimal combination of projects, from a financial perspective, selected.

Capital Expenditures↗
PubMed1996

ABC estimation of unit costs for emergency department services.

Rapid evolution of the health care industry forces managers to make cost-effective decisions. Typical hospital cost accounting systems do not provide emergency department managers with the information needed, but emergency department settings are so complex and dynamic as to make the more accurate activity-based costing (ABC) system prohibitively expensive. Through judicious use of the available traditional cost accounting information and simple computer spreadsheets. managers may approximate the decision-guiding information that would result from the much more costly and time-consuming implementation of ABC.

Cost Allocation↗
PubMed1990

The limited relevance of analytical ethics to the problems of bioethics.

Philosophical ethics comprises metaethics, normative ethics and applied ethics. These have characteristically received analytic treatment by twentieth-century Anglo-American philosophy. But there has been disagreement over their interrelationship to one another and the relationship of analytical ethics to substantive morality--the making of moral judgments. I contend that the expertise philosophers have in either theoretical or applied ethics does not equip them to make sounder moral judgments on the problems of bioethics than nonphilosophers. One cannot "apply" theories like Kantianism or consequentialism to get solutions to practical moral problems unless one knows which theory is correct, and that is a metaethical question over which there is no consensus. On the other hand, to presume to be able to reach solutions through neutral analysis of problems is unavoidably to beg controversial theoretical issues in the process. Thus, while analytical ethics can play an important clarificatory role in bioethics, it can neither provide, nor substitute for, moral wisdom.

Abortion, Legal↗
PubMed1986

DF-2 septicemia following whirlpool spa immersion.

We describe the case of a 31-year-old asplenic man who developed DF-2 bacteremia, septic shock, and pneumonia after recreational immersion in a whirlpool spa. The patient did not have a history of dog bite or contact with canine secretions, although he owned two dogs. DF-2 could not be isolated from the whirlpool spa.

Adult↗
PubMed1982

Aniline blue-containing buffered charcoal-yeast extract medium for presumptive identification of Legionella species.

By utilizing buffered charcoal-yeast extract medium containing 0.01% aniline blue in conjunction with a long-wave UV light, the differentiation of five species of Legionella was facilitated. L. pneumophila, when grown on this medium, did not absorb the aniline blue dye; however, L. micdadei, L. dumoffii, L. bozemanii, and L. gormanii absorbed the dye in varying amounts and produced colonies of various shades of blue.

Aniline Compounds↗
PubMed1982

Novel method of biotyping Haemophilus influenzae that uses API 20e.

One hundred Haemophilus influenzae isolates from various body sites were biotyped by conventional methods and by the API 20E system (Analytab Products, Plainview, N.Y.). By using a hemin- and a nicotinamide adenine dinucleotide-enriched saline solution as the inoculating fluid for the API 20E, a 100% correlation of results was obtained between the two methods. Ninety percent of the blood and cerebrospinal fluid isolates were biotype I. Biotype II was the predominant biotype encountered overall. No correlation was observed between beta-lactamase production and biotype. The API 20E is a reliable method and should prove useful for routine biotyping of H. influenzae in the clinical laboratory.

Bacteriological Techniques↗
PubMed1981

Rapid method for identification of group B streptococci in neonatal blood cultures.

A rapid technique used for the identification of Streptococcus agalactiae, Lancefield group B, from the blood cultures of two neonatal infants is reported. The method utilized the Phadebact Streptococcus Test System (Pharmacia Diagnostics, Piscataway, N.J.) and the supernatant from 13- and 14-h blood cultures. Additional studies with simulated neonatal blood cultures revealed that this method was reproducible. Additional studies also revealed that some non-specific agglutination did occur, which could not be eliminated with dithiothreitol, but was visibly reduced by treatment with soluble staphylococcal protein A.

Agglutination Tests↗
PubMed1980

Follicles and related structures in the pars intermedia of the adenohypophysis of the jird (Meriones unguiculatus).

Two types of follicle composed of non-granulated cells are regularly found in the pars intermedia of the mature jird (Meriones unguiculatus). A few (Type I) are large and cystic with a flattened epithelium bearing some microvilli, but most (Type II) are small and irregular in shape with a cuboidal to low columnar epithelium bearing many microvilli. They are apposed to the granulated chief cells, and contain a strongly PAS-positive material, but no cell debris. The Type II follicles also show crystalloid strands or chains. Villous projections sometimes protrude from the pars nervosa into the follicular lumen. The follicular cells show pinocytotic vesicles, complex interdigitations and invaginated nerves.

Animals↗
PubMed1976

Cyto-differentiation and portal vascular development in the mouse adenohypophysis.

Pituitaries of fetal and postnatal (15 days p.c.-28 days p.n.) and adult (male) mice were studied by light and electron microscopy to correlate the developmental pattern of the hypothalamo-hypophysial vascular system with the time of onset of function of the adenohypophysis. The superior and anterior regions of the adenohypophysis become vascularized at 17 days p.c., when portal vessels extend from oral primary plexus to the pars distalis for the first time. Adenohypophysial vascularity and the number of portal vessels steadily increase to reach the adult pattern at 5 days p.n. At 1 day p.n. deep capillary loops appear in the caudal regions of the oral primary plexus; a capillary (tangential) plexus underlies the ependymal lining of the third ventricle by 6 days p.n. Superficial capillary loops were not observed until the third postnatal week. Granulation of secretory cells commences at 16 days p.c., predominantly in the upper and anterior adenohypophysis; at 17 days thyrotropes, gonadotropes and corticotropes are recognizable and by morphological criteria appear actively secretory on days 17-18 p.c., although few appear active at 19 days p.c. and 1 day p.n. Somatotropes are first seen at 18 days p.c., predominantly in the central and lateral regions of the pars distalis. Active secretory cells increase in number over the period 2-10 days p.n., but after 11 days p.n. thyrotropes and corticotropes seem to become progressively less active; fewer gonadotropes are seen after 15 days p.n., and these apparently become progressively less active from day 19. Most somatotropes appear active until 28 days p.n. The observations suggest that hypothalamic control of adenohypophysial function may exist in the mouse from 17 days p.c.

Age Factors↗
PubMed1975

An explanation fro chloracne -- an industrial hazard.

Patients with chloracne were investigated and the results compared with data matched for age and site from patients with acne vulgaris. The ultrastructural appearances of pilo-sebaceous ducts in both groups were similar. The industrial group had significantly fewer C. acnes than the patients with ordinary acne. They also showed a significant increase in the surface lipid percentage composition of squalene, wax ester and cholesterol and this was associated with a significant decrease in the triglyceride free fatty acids and total triglyceride pool. We suggest that the acnegenic agent has produced its effect by modifying the metabolism of the pilo-sebaceous fluid.

Acne Vulgaris↗
PubMed1973

Tetracycline and acne vulgaris: a clinical and laboratory investigation.

A satisfactory clinical response to long-term oral tetracycline treatment was associated with a mean serum tetracycline of 1.98 mug/ml. The surface lipid showed an increased triglyceride, decreased free fatty acids, and decreased cholesterol, and the amount of keratin within the pilosebaceous duct was reduced. At this dose level there was no quantitative decrease in the bacterial flora though there was a decrease in the fatty acids. We believe that the latter was due to a direct inhibition by tetracycline on extracellular lipases.

Acne Vulgaris↗