Facilities. Building for growth.
Explore the source record for details and available documents.
Architecture↗
SEARCH · PubMed Health
Results for “Capacity Building”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Historic building houses nursery, ICU.
Explore the source record for details and available documents.
History, 18th Century↗
Photoinhibition in seedlings of Fraxinus and Fagus under natural light conditions: implications for forest regeneration?
Ash (Fraxinus excelsior L.) and beech (Fagus sylvatica L.) seedlings were grown in the field under three levels of natural light: (1) open, (2) gap and (3) shade. Light acclimation of photosynthesis was characterized by means of modulated chlorophyll a fluorescence of intact leaves and growth parameters were measured at the end of the growing season. Measurements of maximum photochemical efficiency (Fv/Fm) of dark-adapted leaves at intervals through the day showed that ash had a higher Fv/Fm than beech in open and gap plots but not in shade plots. This indicated a larger build-up of photoinhibition in beech under gap and open conditions. Steady-state light response curves of the operating efficiency of PSII (F'q/F'm), the electron transport rate (ETR) and the photochemical efficiency factor (F'q/F'v) showed greater variability across light treatments in ash than in beech. Both species exhibited similar responses of non-photochemical quenching (NPQ) to light. When the data were normalized to the mean maximum irradiance in the growth environment, all photochemical parameters showed a reduction in variation across treatments, indicating that light acclimation in the two species occurred primarily through adjustments in rates of photochemistry. Adjustments in thermal heat dissipation were small in both species. This pattern was stronger in ash, suggesting a greater degree of phenotypic plasticity in photosynthetic capacity in this earlier successional species. Contrary to our expectations, the build-up of photoinhibition in beech did not appear to have a negative effect on total biomass accumulation relative to ash.
Chlorophyll↗
Estradiol, progesterone, and prolactin regulate maternal nest-building in rabbits.
Maternal nest-building in rabbits, expressed across the last third of pregnancy, consists of: digging a burrow, collecting straw and shaping it into a nest inside the burrow, plucking body hair and lining the straw nest with it. The sequential expression of these activities is correlated with specific changes in the plasma concentration of estradiol, progesterone (P), and prolactin (PRL). To further substantiate the participation of these hormones in the control of maternal nest-building we explored in ovariectomized (ovx) New Zealand white rabbits the capacity of several combinations of such hormones to stimulate digging, straw-carrying, and hair-pulling. Does given estradiol benzoate (EB; 5 micrograms/day from days 3 to 21) plus P (2 or 10 mg/day from days 4 to 16) dug into a substrate from the fourth day of the P treatment until withdrawal of this hormone. The intensity of this effect was greater in the group treated with the high dose of P. Straw-carrying and hair-pulling occurred after P withdrawal in a dose-response way. Food intake, which declines in pregnant females shortly before parturition, decreased to the same extent in both groups of ovx EB-treated does after P withdrawal. A significant increase in PRL plasma levels was observed on day 9 in does given EB plus 2 mg P/day and at two days following P withdrawal in does given EB plus 10 mg P/day. When such ovx EB/P-treated does were given bromocriptine to block PRL release (1 or 3 mg/Kg/day, from days 11 to 21) the expression of digging was unmodified. By contrast, bromocriptine abolished the display of straw-carrying and hair-pulling, and also prevented the decline in food intake normally following P withdrawal. The addition of ovine PRL to ovx EB/P-treated does given bromocriptine reduced the expression of digging, did not restore straw-carrying or hair-pulling, and provoked a sharp decline in food intake. The possible mechanisms of interaction between PRL and steroid hormones for the regulation of specific aspects of the pregnant doe's physiology and behavior are discussed.
Animals↗
Transient blockade of the CD11d/CD18 integrin reduces secondary damage after spinal cord injury, improving sensory, autonomic, and motor function.
The early inflammatory response to spinal cord injury (SCI) causes significant secondary damage. Strategies that nonselectively suppress inflammation have not improved outcomes after SCI, perhaps because inflammation has both adverse and beneficial effects after SCI. We have shown that the selective, time-limited action of a monoclonal antibody (mAb) to the CD11d subunit of the CD11d/CD18 integrin, delivered intravenously during the first 48 hr after SCI in rats, markedly decreases the infiltration of neutrophils and delays the entry of hematogenous monocyte-macrophages into the injured cord. We hypothesized that this targeted strategy would lead to neuroprotection and improved neurological outcomes. In this study the development of chronic pain was detected in rats by assessing mechanical allodynia on the trunk and hindpaws 2 weeks to 3 months after a clinically relevant clip-compression SCI at the twelfth thoracic segment. The anti-CD11d mAb treatment reduced this pain by half. Motor performance also improved as rats were able to plantar-place their hindpaws and use them for weight support instead of sweeping movements only. Improved cardiovascular outcome was shown after SCI at the fourth thoracic segment by significant decreases in autonomic dysreflexia. Locomotor performance was also improved. These functional changes correlated with significantly greater amounts and increased organization of myelin and neurofilament near the lesion. The improved neurological recovery after the specific reduction of early inflammation after SCI demonstrates that this selective strategy increases tissue at the injury site and improves its functional capacity. This early neuroprotective treatment would be an ideal foundation for building later cell-based therapies.
Animals↗
Receptor-mediated and intrinsic polarization and their interaction in chemotaxing cells.
Polarization--the clear and persistent localization of different signaling molecules to opposite ends of the cell-is critical for effective chemotaxis in eukaryotic systems. In many systems, polarization can also occur without an externally imposed chemical gradient. We build a modeling framework to study the relationship between the intrinsic capacity for polarization, and that induced by an external gradient. Working within this framework, we analyze different scenarios for the interaction of these pathways. The models are qualitatively simplified, motivated by known properties of the signaling pathways. We also examine the possible role of nonlinear transitions occurring in the polarization pathways. The modeling framework generates testable predictions regarding the relationship between intrinsic polarization and that induced during chemotaxis, and is the first step toward a systematic analysis of the interaction between these pathways.
Cell Membrane↗
Better communication expected to boost capacity at Sutter Medical Center.
If hospitals were run like motels, many would have 'no vacancy' signs out front these days. For a variety of reasons, most hospitals are operating near capacity. Of course, hospitals don't like to turn away patients, so they build new space and look for ways to get patients in and out faster. Sutter Medical Center in Sacramento, CA, thinks it has hit upon the answer with a computer system that automates the patient flow management process and makes communication between staff members more efficient.
Academic Medical Centers↗
Centers of excellence: Johns Hopkins ambulatory care building.
Explore the source record for details and available documents.
Ambulatory Care Facilities↗
Hospital safeguards capital program through private sector partnership.
As access to capital tightens, more hospitals are exploring the benefits of partnerships with private companies. A California hospital, burdened by the long-term debt it incurred for a medical office building, worked together with its medical staff and an outside real estate developer. By selling the building to the developer, not only was the hospital able to finance a much-needed expansion and reconstruction project, but the hospital's medical staff had an opportunity to become limited partners in the ownership of the building.
California↗
Building a dream: creating an oncology day/evening hospital.
The demand for inpatient beds has reached and often exceeds capacity producing waiting lists for cancer care. There is a need to explore alternative approaches to oncology treatment. The Oncology Day/Evening Hospital (ODEH), originally envisioned in 1995 as a joint project between an ambulatory cancer centre and a large teaching hospital, is an important cancer treatment initiative offering extended hours of ambulatory oncology treatment on days, evenings, weekends and statutory holidays. A review of current inpatient treatment modalities revealed that many patients receiving inpatient therapy could be safely and effectively managed in the ambulatory setting if treatment regimens were modified and if ambulatory hours of operation were extended. Healthcare improvements expected were: appropriate movement of inpatient activity to the ambulatory setting; more opportunities for patient choice in treatment time thereby allowing for maintenance of normal living; better quality of life for patients through prevention of hospitalization; decrease in treatment waiting times; consolidation of patients into an ambulatory oncology treatment setting as opposed to utilization of adult medicine units; and more rational inpatient bed utilization with reduction of admissions and intra-treatment transfers. This article describes our experience in building a dream, the challenges and lessons learned in implementing a better way to deliver oncology care in an environment of rapid change and staff shortages.
Ambulatory Care↗
The schizophrenic and the paranoid process.
Data are presented in support of an understanding of schizophrenic and paranoid processes as operating relatively independently in the formation and deformation of human personality. The schizophrenic process derives from a genetically determined diathesis in combination with a range of factors involving environmental stress. The effects of the schizophrenic process in the organization and integration of internal structure and the differentiation of psychic functions are found at multiple levels, including negative consequences for the integration between cognitive and affective capacities, between conceptual and perceptual functions, and in the integration and stabilization of psychic structures. The schizophrenic process is envisioned as having disorganizing and disruptive effects on different levels of psychic organization, including the levels of the organization of cognitive processes, the formation and integration of representational systems (both self and object, and the structural integration of the self-system. In contrast, the paranoid process is thought to operate in the shaping and internal patterning of the personality organization, particularly by way of crucial forms of internalization. The interaction of introjection and projection shapes the individual's self-organization and contributes to the quality of interaction with significant objects. The impact of the paranoid process in both its positive function of contributing to the building up and integration of a meaningful and constructive sense of self and capacity for psychological functioning, as well as its deviant forms of expression in the development of paranoid pathology, is discussed. Although the schizophrenic and paranoid processes operate relatively independently, their interaction and intermingling contributes to the spectrum of forms of psychopathology that characterize the schizophrenic spectrum.
Cognition↗
Building our future: a plea for leadership.
In recent years the spastic nature of the health care marketplace has continued to increase, which has greatly escalated the demands of leadership in academic medical centers. The expectations of leaders, including surgery chairs, have increased considerably, whereas their capacity for independent action has undeniably diminished. In such a predicament, it is useful to revisit fundamentals, using them as a guide to build a sound future. Five leadership principles are critical to building a better future: (1) recognizing that the work of leadership involves an inward journey of self-discovery and self-development; (2) establishing clarity around a set of core values that guide the organization as it pursues its goals; (3) communicating a clear sense of purpose and vision that inspires widespread commitment to a shared sense of destiny; (4) building a culture of excellence and accountability throughout the entire organization; and (5) creating a culture that emphasizes the development of leaders and leadership as an organizational capacity. Leadership and learning are inextricably linked. We must change the perception that learning in academic surgery is about correcting a deficit rather than a natural part of human growth and development. Our ability to learn, grow, and contribute to an organization is what provides each of us with meaning and identity. This feeling of being part of something special that is larger than ourselves is a powerful force and an important dividend of great leadership.
Academic Medical Centers↗
The influence of age, alcohol consumption, and body build on gonadal function in men.
Basal plasma levels of testosterone, dihydrotestosterone, estradiol, and gonadotropins and testosterone-binding capacity (percent radioactive testosterone bound to protein) were measured in health carefully screened young (31-44 yr old; n = 44) and older (64-88 yr old; n = 42) male participants in the Normative Aging Study of the V.A. There was no statistically significant effect of age on testosterone [younger group, 4.16 +/- 0.27 (SEM) ng/ml; older group, 4.62 +/- 0.32 (SEM) ng/ml] or the free testosterone index [younger group, 2.05 +/- 0.14 (SEM) ng/ml; older group, 1.76 +/- 0.11 (SEM) ng/ml]. The testosterone-binding capacity was higher in the older group (younger group, 50.10 +/- 1.18% (SEM); older group, 60.10 +/- 1.18% (SEM); P less than 0.001). Of the two products of testosterone metabolism studied, estradiol did not change with age, while dihydrotestosterone was lower [young group, 0.25 +/- 0.02 (SEM) ng/ml; older group, 0.20 +/- 0.01 (SEM) ng/ml; P = 0.03] in the older group. FSH levels were increased among the older men [older group, 92.9 +/- 6.0 (SEM) ng/ml; younger group, 61.1 +/- 5.0 (SEM) ng/ml; P less than 0.001]. LH levels were not significantly influenced by age. There was no effect of level of chronic stable alcohol intake on gonadal function, as estimated by testosterone levels and the free testosterone index. Analysis of the relationship between body build and hormone levels indicated that estradiol levels were highest in gynandromorphic men and lowest in mesomorphic men.
Adult↗
Shielding requirements on-site loading and acceptance testing on the Leksell gamma knife.
On August 14, 1987, the first stereotactic radiosurgical procedure using the gamma knife was performed in North America. Located in a self-contained radiosurgical suite in the basement of Presbyterian-University Hospital in Pittsburgh, Pennsylvania. This device uses 201 highly focused beams 60Co for the single-treatment closed-skull irradiation of brain lesions localized by stereotactic techniques (radiosurgery). One hundred and fifty-two patients with intracranial arteriovenous malformations or brain tumors were treated in the first year of operation. The Presbyterian University Hospital of Pittsburgh gamma knife is the first such unit in which the 60Co sources were loaded on-site. This effort required us to solve some difficult and unusual problems encountered during site preparation, delivery, and loading of the unit in a busy hospital setting. The solutions developed enabled installation and use of the gamma knife with minimal disruption of hospital activities while maintaining acceptable levels of exposure to radiation. Environmental surveys performed during the loading of the 201 radioactive sources (total, 219 TBq) confirmed that on-site loading is possible and practical. Our experience in the design, construction, and implementation of the first North American gamma knife supports the practicality and safety of on-site loading and may be of value in the planning and development of future gamma knife installations.
Brain Neoplasms↗
A dental workforce review for a Midlands Strategic Health Authority.
OBJECTIVE: To explore opportunities for workforce development in NHS general dental services (GDS) in Shropshire and Staffordshire. METHOD: Secondary data sources were supplemented with a primary survey of GDS practices to build up a profile of the existing GDS workforce and its current capacity. Attitudes and perceptions on current workforce issues and potential solutions were gathered using a second survey and explored further through other qualitative techniques including interviews and a focus group discussion. RESULTS: The results confirm that there is a shortage of dentists in the area, fuelled by multiple factors including the move from NHS to private work, the decision to retire early and a growing disillusionment with NHS policies and remuneration. Modelling of alternate approaches to future dental clinical needs highlighted the opportunity for meeting the consequent workforce demands through increased involvement of hygienists and therapists. CONCLUSIONS: This study has provided local evidence to inform dental service development in Shropshire and Staffordshire. It has provided a starting point for exploring new ways of working and will contribute towards a more effective implementation of new and evolving service strategies.
Attitude of Health Personnel↗
Electron microscopy study of genesis and dynamics of immunodeposition in IgMk-IgG cryoglobulin-induced glomerulonephritis in mice.
Cryoglobulinemic glomerulonephritis is particularly frequent in type II mixed IgMk-IgG cryoglobulinemia. The typical form is a membranoproliferative glomerulonephritis with a particular monocyte infiltration. In the most severe cases, there is occlusion of the capillary lumina by the same immunoglobulin constituents of the cryoprecipitate. While it is generally accepted that the "hyaline thrombi" are endoluminal aggregates of IgG-IgM immune complexes, probably favored by high endocapillary concentration of cryoglobulins, the modality of generation has not been studied. To study the dynamic formation of such "thrombi," we reproduced an experimental model of cryoglobulinemic glomerulonephritis in mice by injecting them twice a day for 3 days with 4 mg human IgMk-IgG cryoglobulins previously solubilized at 37 degrees C. The dynamic formation of immunodeposits was studied by immunofluorescence and electron microscopy. After 1 day, only mesangial deposits were found; after 3 days, in addition to mesangial deposition, all the capillary lumina were occluded by huge electron-dense bodies. To look for and quantify the contacts between such "thrombi" and mesangial or subendothelial deposits, we obtained serial, ultrathin, 0.5-microm sections that allowed us to reconstruct the whole glomerular tuft. Within each serial section, there was continuity between hyaline thrombi and mesangial or subendothelial deposits ranging from 80% to 85% of the capillary loops. The percentage was 100% for two adjacent serial sections. In conclusion, our data demonstrate directly for the first time that hyaline thrombi follow mesangial deposits. The high percentage of contacts between thrombi and mesangial or subendothelial deposits suggests that they result from in situ build-up of true huge endoluminal immunodeposits after saturation of the clearance capacity of the mesangium.
Aged↗
The relationship between indicators of building dampness and respiratory health in young Swedish adults.
Several epidemiological studies have indicated that building dampness affects the respiratory health of the inhabitants. In this study we investigated the relationship between building dampness and respiratory symptoms in young Swedish adults. In 1993, as a part of the European Community Respiratory Health Survey stage II, subjects were invited to participate in a detailed interview-led questionnaire, spirometry, methacholine challenge and measurement of total and specific IgE. A total of 1853 of the 2084 selected subjects participated in this study (88.9%). One hundred and thirty-six (7.4%) subjects reported water damage in their homes in the last year and 318 (17.3%) subjects reported visible molds during the same period. Seventy-four (4%) subjects reported both water damage and visible molds in the last year. This subgroup, with 74 subjects had significantly more attacks of breathlessness both when resting (OR 3.2 (95% CI 1.4-7.2)) and after effort (OR 2.7 (95% CI 1.3-5.6)) compared to subjects reporting no water damage or molds. Long-term cough was also more common in this group (OR 2.2 (95% CI 1.2-4.0)). This study adds evidence to a relationship between damp buildings and respiratory symptoms.
Adult↗
Causes and consequences of rural small hospital closures from the perspectives of mayors.
Mayors of rural towns whose small general hospitals closed between 1980 and 1988 were surveyed. Only hospitals that were the sole hospitals in their towns and that had not reopened were included in the survey. Of the 132 hospitals meeting these criteria, 130 (98.5%) of the mayors of their communities responded to the survey. The typical study hospital had 31 beds, with an average daily census of 12. Three fourths of the hospital closures were in the North-Central and South census regions. Half of the hospital closures were for hospitals that were 20 miles or more from another hospital. Mayors attributed the closure of their hospitals primarily to governmental reimbursement policies, poor hospital management and lack of physicians. To a lesser extent, they also implicated competition from other hospitals, reputation for poor quality care, lack of provider teamwork, and inadequate hospital board leadership. Respondents reported they had little warning that their hospitals were in imminent danger of closing. Warnings of six months or less were reported by 49 percent of the mayors; only 33 percent of mayors of towns with for-profit hospitals reported having more than six months warning. Of the 132 hospital buildings that closed, only 38 percent were not in use in some capacity in the summer of 1989. Most were being utilized as some form of health care facility such as an ambulatory clinic, nursing home, or emergency room. More than three fourths of the mayors felt access to medical care had deteriorated in their communities after hospital closure, with a disproportionate impact on the elderly and poor. Nearly three fourths of the mayors also perceived that the health status of the community was worse because of the hospital closure, and more than 90 percent felt it had substantially impaired the community's economy.
Community-Institutional Relations↗