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This notice provides the population figures the Department will use when it determines the amount of grants to State Health Planning and Development Agencies (States Agencies).
This article gives practical advice about how to plan, develop and present a business plan for group practices. The author urges groups to document their business strategies because it provides a "financial road map" to assist in the affairs of the group. It will lay a suggested foundation and methodology for you to use. He recommends sources of information and examples of how his group practice goes about developing their business plan.
OBJECTIVES: It is now possible to test individuals to assess their cystic fibrosis gene carrier status and a range of strategies for screening the population have been piloted. The objective of this research was to develop a planning framework which health care planners and purchasers can use to assess the overall quantifiable outcomes and direct costs resulting from a year of alternative screening strategies and the ways costs and outcomes evolve over time. Beyond broader ethical and clinical considerations the information provided by such a framework is needed to support decisions surrounding the development of screening programmes. DESIGN: Operational Research modelling techniques were used to develop the planning framework. To help illustrate the framework it was then used to assess the quantifiable outcomes and direct costs of three of the main alternative screening strategies: from antenatal clinics, '2-step' screening where females are tested first followed by a screening invitation to the partners of female carriers, and 'couple' screening where both partners must agree to be tested at the outset; and from primary practice clinics 'active' contact of attenders. Quantifiable outcomes are defined as the number of individuals informed of their carrier status and the number of carriers, carrier couples, and affected fetuses detected. Direct costs are those associated with the recruitment and testing of individuals and the subsequent counselling of any gene carriers or carrier couples identified. Results are based on services for a resident population of 250,000 at two time points, year one and a year at 'steady state'. RESULTS: The resultant framework estimates the number of individuals tested using data on the size of the target population, the proportion of that population alerted to the screening service, and the proportion who agree to be tested when approached. Given service users, prevalence data are used to assess service outcomes. Given the number of individuals approached and the subsequent demands for services, service costs can be estimated. Preliminary results indicate that in the short-term health care purchasers and planners who favour screening are likely to opt for antenatal strategies. Although the high coverage of the primary practice strategy leads to high outcomes in year one, relative to the antenatal strategies, it also leads to very high costs. At 'steady state', cost and outcome differences between the strategies are less marked. CONCLUSION: This paper provides a framework which can be used to provide information to support decision-making surrounding the development of screening services. The methodology fills an important void in the literature and complements research elsewhere by health economists and by geneticists and their research colleagues. Preliminary findings based upon use of the approach demonstrate the need for continued research to further refine and improve the methodology.
The career planning process is often illustrated as the last step in an ever-changing work environment. The technical, professional, managerial, and interpersonal skills to successfully perform and succeed in this rapidly changing work environment are essential. There is a very real and immediate threat that many of the professional skills that we have learned yesterday and today will be obsolete and insufficient to cope with the inevitable changes in the future. While most professionals are aware of the very real threat of skill obsolescence, few take the opportunity to do definitive career planning regarding their future. The career planning process is designed to help individuals examine their careers; evaluate their training and educational needs; and develop some specific action plans to maintain, enhance, and reevaluate the relevance of their professional and managerial skills in a work environment that values rapid change and adaptation.
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This article outlines the approaches taken to the management of two long-term care facilities by the County of Huron in southwestern Ontario in 1994. Lay-offs, a move to new facilities, loss of local political confidence, changes in key administrative personnel and low staff morale prompted the county to ask an interim administrative team to develop and implement an appropriate response. The article explains how community development and planning principles and techniques were applied to the management of the homes to achieve an overall improvement in communication, staff morale and attitude. These approaches may prove helpful to other administrations facing major change.
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Developing a strategic information plan is an essential step for companies that want to realize the advantages of today's information technology. This article discusses ways to avoid the pitfalls that frequently occur during stages of information planning.
Developments in radiation therapy planning have improved the information about the three-dimensional dose distribution in the patient. Isodose graphs, dose volume histograms and most recently radiobiological models can be used to evaluate the dose distribution delivered to the irradiated organs and volumes of interest. The concept of a biologically effective uniform dose (D) assumes that any two dose distributions are equivalent if they cause the same probability for tumour control or normal tissue complication. In the present paper the D concept both for tumours and normal tissues is presented, making use of the fact that probabilities averaged over both dose distribution and organ radiosensitivity are more relevant to the clinical outcome than the expected number of surviving clonogens or functional subunits. D can be calculated in complex target volumes or organs at risk either from the 3D dose matrix or from the corresponding dose volume histograms of the dose plan. The value of the D concept is demonstrated by applying it to two treatment plans of a cervix cancer. Comparison is made of the D concept with the effective dose (Deff ) and equivalent uniform dose (EUD) that have been suggested in the past. The value of the concept for complex targets and fractionation schedules is also pointed out.
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Development of the animal body plan is controlled by large gene regulatory networks (GRNs), and hence evolution of body plans must depend upon change in the architecture of developmental GRNs. However, these networks are composed of diverse components that evolve at different rates and in different ways. Because of the hierarchical organization of developmental GRNs, some kinds of change affect terminal properties of the body plan such as occur in speciation, whereas others affect major aspects of body plan morphology. A notable feature of the paleontological record of animal evolution is the establishment by the Early "Cambrian of virtually all phylum-level body plans. We identify a class of GRN component, the kernels" of the network, which, because of their developmental role and their particular internal structure, are most impervious to change. Conservation of phyletic body plans may have been due to the retention since pre-Cambrian time of GRN kernels, which underlie development of major body parts.
Development of the Northwest Forest Plan (NWFP) was motivated by concerns about the over-harvest of late-seral forests and the effects of intensive forest management on the long-term viability of the Northern Spotted Owl (Strix occidentalis caurina). Following several years of intense political and legal debates, the final NWFP was approved in 1994. Even though the plan evolved with a broad ecosystem perspective, it remained anchored in the Spotted Owl reserve design proposed in 1990. Based on a criterion of stable or increasing populations, a decade later it remains unclear whether the enactment of the NWFP has improved the conservation status of Spotted Owls. The results of intensive monitoring of several Spotted Owl populations for over a decade suggest a continuing range-wide decline even though rates of timber harvest have declined dramatically on federal lands. The cause of the decline is difficult to determine because the research needed to establish cause and effect relations has not been done. One plausible hypothesis is that the owl's life history greatly constrains its rate of population growth even when habitat is no longer limiting. Since enactment of the NWFP, new threats have arisen, including the movement of Barred Owls (S. varia) into the range of the Spotted Owl, political pressure to increase levels of timber harvest, and recent changes to forest laws that eliminate the requirement to assess the viability of wildlife populations on U.S. Department of Agriculture Forest Service lands. At this time is appears that Spotted Owl conservation rests critically on continued implementation of the protections afforded by the NWFP and the U.S. Endangered Species Act.
From 1998 to 2001, the relationship between the proportion of tillers with >0 mummified aphids (Ptm) and the proportion of cereal aphids parasitized (Pp) was estimated on 57 occasions in fields of hard red winter wheat located in central and western Oklahoma. Both original (57 fields) and validation data (34 fields; 2001-2002) revealed weak relationships between Ptm and Pp, however, when Ptm > 0.1, Pp always exceeded the recommended parasitism natural enemy threshold of 0.2. Based on the relationship between Ptm and Pp, upper (Ptm1) and lower (Ptm0) decision threshold proportions were set at 0.1 and 0.02, respectively. We monitored cereal aphid populations in 16-25 winter wheat fields over time, and based on the upper and lower decision threshold proportions (Ptm1 = 0.1, Ptm0 = 0.02), predicted whether aphid intensities (# per tiller) would increase above or be maintained below selected economic thresholds (3, 9, and 15 aphids per tiller). Results of this validation study revealed that aphid intensity exceeded an economic threshold in only one field when predicted to remain below Ptm > 0.1, but aphid intensity reached a maximum of only four aphids per tiller. The sampling plan developed during this study allowed us to quickly classify Ptm, and independent of initial cereal aphid intensities, very accurately predict suppression of populations by parasitoids. Sequential sampling stop lines based on sequential probability ratio tests for classifying proportions were calculated for Ptm1 = 0.1 and Ptm0 = 0.02. A minimum of 26 tiller samples are required to classify Ptm as above 0.1 or below 0.02. Based on the results of this study, we believe that simultaneous use of aphid and parasitoid sampling plans will be efficient and useful tools for consultants and producers in the southern plains and decrease the number of unnecessary insecticide applications.
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The Council on Long Range Planning and Development has undertaken an analysis of the future of medicine. The purpose in undertaking this study was to examine how the changing environment might effect the AMA and to identify measures the AMA could take to ensure its success in the future. The study involved developing three scenarios that covered a broad range of possibilities for the future. Analysis of these scenarios indicated that the AMA could face some significant environmental threats in the future. In the opinion of the Council, a variety of factors could combine to erode the AMA's membership market share and reduce cooperation among Federation organizations. Consequently, the AMA will have to develop an active response to environmental change to success and thrive in the future. The Council analyzed how the AMA might best respond to environmental change. The AMA could intensify its efforts to guide the course of environmental change. Such efforts would be worth undertaking, but they do not represent a complete solution. Therefore, the AMA must change itself to succeed in the future. The Council analyzed a number of alternative models of the AMA, each representing changes in product mix and/or organizational structure. None of these models provide a solution to environmental change. Rather, the solution lies primarily in program and activity changes. The Council identified specific suggestions for changes in the AMA's activities, organizational structure, and finances. If these suggestions are implemented, they will help the AMA succeed in the emerging environment. After completing its study of the future of medicine, the Council concluded that the need for the AMA will persist in the future. The market for the Association's products and services will remain strong. By taking steps today, the AMA can position itself to benefit from the emerging environment and, thereby, ensure that the Association has a positive future.
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This paper describes a two-stage review relating to the family-centred public health role of health visitors and the child-centred public health role of school nurses. During the first stage, literature was searched using CINAHL and Medline databases and two models were used to frame the literature analysis. The findings of this analysis were, however, disappointing. Although many policy documents advocate development of the family-centred public health role of health visitors and the child-centred public health role of school nurses, there was no overwhelming evidence of reports of these approaches in health visiting and school nursing practice. The second stage of the review comprised a content analysis of West Midlands community trusts' strategic development plans. Seventeen plans were analysed. Of these, only two were 'formal' plans, the remainder being fragmented documentation related to plans for the development of health visiting and school nursing services. It may be concluded from the analysis that NHS trusts are beginning to adopt ideas from the rhetoric of national policy documents. Additionally, public health practice initiatives form an integrated part of most of the trust strategic development plans that the researchers examined.
Developing and implementing successful marketing strategies for prepaid health care coverage plans is becoming an important issue as managers of these plans struggle to remain competitive in the market place. This paper provides insight into the reasons why consumers make choices among varying types of health care coverage plans. Some suggestions are made to plan managers for incorporating these results into the development of marketing strategies for prepaid health care coverage plans.