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PubMed2004

Adapting to change in healthcare: aligning strategic intent and operational capacity.

The concept of a stakeholder is commonplace in a business context. Participative- democratic communication refers to those organization-wide principles and practices that "represent" many relevant stakeholders in the decision making of work-related activities. One case in point is as follows: In May 2000, the Spartanburg Regional Healthcare System board of directors forced its CEO to resign, ending his 6-year tenure and the heated controversy of the previous 2 months. The former CEO focused primarily on strategic growth to the detriment of operations. Through participative-democratic practices, the interim CEO mended the damaged relations between the hospital administration, the community, and employee stakeholders in surfacing conflict to bolster operational efficiency. The current CEO attended to building stakeholder relationships and trust as a way to wed strategic growth and the organization's capacity to maintain it. Top executive managers and directly involved community political leaders helped in developing the participative-democratic communication principles set forth in this article. These core principles are (a) creating the space for new communicative interaction, (b) safeguarding a credible and open process, and (c) reclaiming suppressed views.

Community-Institutional Relations↗
PubMed1998

Nest building is a sexually selected behaviour in the barn swallow.

Females may use male nest building to assess male parental quality, and nest size would then be a sexually selected trait. In the barn swallow, Hirundo rustica, females select their partner by his tail length, a character believed to signal good genes. Both sexes participate in nest building, although male participation is negatively related to his attractiveness as reflected by tail length. We tested the hypothesis that nest building is a sexually selected trait: females paired with males of high parental quality (as shown by the male during nest building) may obtain a mate providing large amounts of parental investment, while, as has been shown previously, females mated to attractive (long-tailed) males will acquire mates with good genetic quality. Therefore, since nest building in barn swallows occurs after mating, we predicted a postmating sexual selection process by which the female invests differentially in reproduction depending on the male's nest-building effort (reflecting his willingness to invest in reproduction). The volume of material in a nest was related to the male's contribution to nest building and, in agreement with our hypothesis, in a multiple regression analysis, male tail length and nest material volume were negatively related to laying date and positively to female investment in reproduction (total number of eggs laid during the breeding season). Moreover, females paired with long-tailed males (which contribute very little to nest building), but using the same amount of nest material as females paired with short-tailed males, reduced the thickness of the nest and hence increased its capacity. Therefore, in the barn swallow two different traits appear to be sexually selected: tail length of males owing to the good genes process and nest-building ability owing to the good parent process. (c) 1998 The Association for the Study of Animal Behaviour.

Journal Article↗
PubMed1989

Effective staff communications in a large I.C.U.

A byproduct of the Quality Assurance process is the continual review of individual and group practice. The aim is to eliminate errors and to improve care. For managers and directors to know what issues are currently important to the staff members an upward channel of communication is also needed. In our SICU with over 120 staff there was no documentation of communication in either direction. Casual survey did not reveal a major problem - but the need to document the dissemination of information, particularly new policies - especially to satisfy accrediting agencies - led us to develop MEMOS, an electronic mail system for staff members within the local area network (LAN) in the SICU. The system will run on an individual PC. The network is used because of the physical configuration of the intensive care units. The system is used by nurse managers to keep staff members up to date. Features include: Easy file maintenance. Individual password access. A defined group of system operators with access to all system functions Limited access to all other users. As many as 40 definable sub-groups for the purposes of mail distribution. Easy operator tallying of those delinquent in reading their mail. Hard copy with distribution list for all memos added to system. Browse feature to allow re-reading of old memos. Feedback channel regularly read by system operators. This system has improved the level of staff awareness in the SICU and helped build morale.

Computer Systems↗
PubMed2006

If you build it, they will come: lessons from developing walking trails in rural Missouri.

Given the high rates of sedentary behaviors, attempts to increase physical activity have incorporated individual and, more recently, policy and environmental approaches for promotion of activity. This article presents a summary of the approaches being used by the Ozark Heart Health Coalitions in developing walking trails in rural Missouri. In summarizing these approaches the authors describe 10 lessons with the aim of articulating the process and, thereby, increasing interest and capacity in development of walking trails. Qualitative and quantitative data were used to show burden and priorities and build support with numerous stakeholders. Stakeholders were engaged to identify common objectives, obtain land and funding, and determine trail size, materials, and time needed for construction. Implementation activities focused on trail maintenance and addition of amenities (e.g., playgrounds, benches). In the area of evaluation, they collect data via interviews with walkers on trails and community telephone surveys.

Community-Based Participatory Research↗
PubMedDate not supplied

Drawing women into prenatal care.

Participation in prenatal care services in the United States is low relative to that in many other developed countries, and rates of use are declining among some high risk groups. In 1986, 18 percent of all U.S. infants were born to women who delayed care until the second trimester of pregnancy; four percent, to women who initiated care in the third trimester; and about two percent, to women who obtained no prenatal care at all. Among the major barriers to prenatal care are inadequate insurance coverage, limitations in the Medicaid program, inadequate capacity in the maternity care system, lack of coordination between health and social services for low-income women and inhospitable conditions at some sites where prenatal care is delivered. The personal beliefs, knowledge, attitudes, fears and lifestyles of some pregnant women also constitute obstacles to care. For example, having an unwanted pregnancy, attaching little value to prenatal care and having a tenuous connection to the health care system in general are important predictors of insufficient care. Encouraging universal participation in prenatal care will require a major overhaul of the maternity care system. However, while consensus for fundamental reform builds, several immediate steps should be taken--such as reducing financial barriers to care; expanding the capacity of the maternity care system; improving the policies and practices that shape prenatal services at the site where they are delivered; and increasing public information.

Adolescent↗
PubMed2006

Economic, neurobiological, and behavioral perspectives on building America's future workforce.

A growing proportion of the U.S. workforce will have been raised in disadvantaged environments that are associated with relatively high proportions of individuals with diminished cognitive and social skills. A cross-disciplinary examination of research in economics, developmental psychology, and neurobiology reveals a striking convergence on a set of common principles that account for the potent effects of early environment on the capacity for human skill development. Central to these principles are the findings that early experiences have a uniquely powerful influence on the development of cognitive and social skills and on brain architecture and neurochemistry, that both skill development and brain maturation are hierarchical processes in which higher level functions depend on, and build on, lower level functions, and that the capacity for change in the foundations of human skill development and neural circuitry is highest earlier in life and decreases over time. These findings lead to the conclusion that the most efficient strategy for strengthening the future workforce, both economically and neurobiologically, and improving its quality of life is to invest in the environments of disadvantaged children during the early childhood years.

Adult↗
PubMed2003

Efficiency of particle retention and clearance rate in the polychaete Sabellaria alveolata L.

The development of Sabellaria alveolata, a gregarious reef-building polychaete species, is maximal in Mont-Saint-Michel Bay (France), where trophic capacity is now threatened by increasing shellfish farming. As no data are available concerning the ecophysiological response of this species, the purpose of the present study was to obtain clearance rate and retention efficiency values to provide a first order of magnitude for the trophic role of this species. Data were obtained using a flow-through system with novel troughs suitable for 225 cm2 reef blocks containing a mean number of 940 +/- 102 (S.E.) individuals. The experimental diet used consisted of a mixture of two live microalgae, Skeletonema costatum (3800 cell ml-1) and Isochrysis galbana (23,700 cell ml-1), chosen to cover a broad size range (2 to 16 microns equivalent spherical diameter, ESD), as determined by a particle counter. On the basis of a mean clearance rate of 0.7 lh-1 obtained with reef blocks, the mean rate for an individual was estimated at 7.5 x 10(-4) L h-1. Particles larger than 6 microns ESD were cleared with 100% efficiency, but S. alveolata was unable to retain particles smaller than 2 microns ESD. The results are compared with data obtained for other polychaete species, and clearance rate values are extrapolated to an entire reef.

Animals↗
PubMed1998

Interactions between serine acetyltransferase and O-acetylserine (thiol) lyase in higher plants--structural and kinetic properties of the free and bound enzymes.

The last steps of cysteine synthesis in plants involve two consecutive enzymes. The first enzyme, serine acetyltransferase, catalyses the acetylation of L-serine in the presence of acetyl-CoA to form O-acetylserine. The second enzyme, O-acetylserine (thiol) lyase, converts O-acetylserine to L-cysteine in the presence of sulfide. We have, in the present work, over-produced in Escherichia coli harboring various type of plasmids, either a plant serine acetyltransferase or this enzyme with a plant O-acetylserine (thiol) lyase. The free recombinant serine acetyltransferase (subunit mass of 34 kDa) exhibited a high propensity to form high-molecular-mass aggregates and was found to be highly unstable in solution. However, these aggregates were prevented in the presence of O-acetylserine (thiol) lyase (subunit mass of 36 kDa). Under these conditions homotetrameric serine acetyltransferase associated with two molecules of homodimeric O-acetylserine (thiol) lyase to form a bienzyme complex (molecular mass approximately 300 kDa) called cysteine synthase containing 4 mol pyridoxal 5'-phosphate/mol complex. O-Acetylserine triggered the dissociation of the bienzyme complex, whereas sulfide counteracted the action of O-acetylserine. Protein-protein interactions within the bienzyme complex strongly modified the kinetic properties of plant serine acetyltransferase: there was a transition from a typical Michaelis-Menten model to a model displaying positive kinetic co-operativity with respect to serine and acetyl-CoA. On the other hand, the formation of the bienzyme complex resulted in a very dramatic decrease in the catalytic efficiency of bound O-acetylserine (thiol) lyase. The latter enzyme behaved as if it were a structural and/or regulatory subunit of serine acetyltransferase. Our results also indicated that bound serine acetyltransferase produces a build-up of O-acetylserine along the reaction path and that the full capacity for cysteine synthesis can only be achieved in the presence of a large excess of free O-acetylserine (thiol) lyase. These findings contradict the widely held belief that such a bienzyme complex is required to channel the metabolite intermediate O-acetylserine.

Acetyltransferases↗
PubMed1999

Association of Ixodes pacificus (Acari: ixodidae) with the spatial and temporal distribution of equine granulocytic ehrlichiosis in California.

This study was conducted to determine if the biology of certain ticks associated with horses regulates the spatial and temporal distribution of equine granulocytic ehrlichiosis (EGE) in California north of Monterey County. We compared the spatial and temporal distribution of EGE cases with the seasons of activity and life histories of ticks that infest horses. Spatially, cases collected from equine veterinarians clustered around each other in a manner different from the way in which control cities of practice were distributed, with foci limited to the Sierra Nevada and coastal foothills. Cases also clustered seasonally: most were diagnosed between November and April. The spatial and temporal pattern of EGE cases closely parallels the well-characterized life history and distribution of Ixodes pacificus Cooley & Kohls, but not other ticks commonly associated with horses. Building on previous studies, there is compelling evidence that this tick has the vectorial capacity to transmit Ehrlichia equi to horses. Based on the life history and distribution of I. pacificus in relation to EGE cases, we reason that this tick is the only biologically plausible vector of E. equi in California, and provide evidence for a tightly linked association between I. pacificus and the epidemiology of EGE.

Animals↗
PubMed2003

Integration of different data bodies for humanitarian decision support: an example from mine action.

Geographic information systems (GIS) are increasingly used for integrating data from different sources and substantive areas, including in humanitarian action. The challenges of integration are particularly well illustrated by humanitarian mine action. The informational requirements of mine action are expensive, with socio-economic impact surveys costing over US$1.5 million per country, and are feeding a continuous debate on the merits of considering more factors or 'keeping it simple'. National census offices could, in theory, contribute relevant data, but in practice surveys have rarely overcome institutional obstacles to external data acquisition. A positive exception occurred in Lebanon, where the landmine impact survey had access to agricultural census data. The challenges, costs and benefits of this data integration exercise are analysed in a detailed case study. The benefits are considerable, but so are the costs, particularly the hidden ones. The Lebanon experience prompts some wider reflections. In the humanitarian community, data integration has been fostered not only by the diffusion of GIS technology, but also by institutional changes such as the creation of UN-led Humanitarian Information Centres. There is a question whether the analytic capacity is in step with aggressive data acquisition. Humanitarian action may yet have to build the kind of strong analytic tradition that public health and poverty alleviation have accomplished.

Agriculture↗
PubMed2005

Multi-agency working in support of people with intellectual disabilities.

Although health and social services in Northern Ireland are jointly commissioned and delivered, the recent emphasis in government policy on multi-agency working for people with learning disabilities has not extended as yet to the region. A qualitative research study, with informants drawn from a range of sectors and agencies beyond health and social services, nonetheless identified at least 24 different organizations who were participating in some form of joint working. The benefits were seen to outweigh potential difficulties and respondents identified the factors that they had found facilitated joint working as well as the obstacles to it. These centred on the need to build relationships among participants, creating opportunities for partnership working to occur and increasing the capacity of individuals and organizations to work together. The need for further evaluation and research into system change and user involvement is highlighted.

Cooperative Behavior↗
PubMed1982

Hypnosis in nursing practice--emphasis on the "problem patient' who has pain--Part II.

The program of treating burned patients with hypnosis was expanded to treating multi-problem and chronic pain patients on the same surgical unit at Denver General Hospital. The majority of patients received some benefit. Many gained control over intense pain and many increased their sense of self-esteem and mastery. The behavioral problems diminished and the staff became reinterested and reinvolved with these very needy people. Whether or not nurses elect to practice hypnosis, the principles are familiar and can be added to the repertory of nursing practice. Physical and psychological relaxation relieves distress and potentiates patients' comfort with or without pain medication. Communicate to the patient that what you are doing builds confidence and increases the probability that treatment wil be effective. Furthermore, recognizing imaginary capacities as powerful in promoting comfort adds an option for intervention not always considered or used by nurses. Whether or not nurses describe what they do as "hypnosis," the use of these techniques can be useful to their practice and to the patients in whom they attempt to alleviate suffering and promote comfort and growth.

Autosuggestion↗
PubMed2000

Organizing and managing care in a changing health system.

OBJECTIVE: To examine ways in which the management and organization of medical care is changing in response to the shifting incentives created by managed care. DATA SOURCES: Site visits conducted in 12 randomly selected communities in 1996/ 1997. STUDY DESIGN: Approximately 35-60 interviews were conducted per site with key informants in healthcare and community organizations; about half were with providers. DATA COLLECTION: A standardized interview protocol was implemented across all sites, enabling cross-site comparisons. Multiple respondents were interviewed on each issue. PRINCIPAL FINDINGS: A great deal of experimentation and apparent duplication exist in efforts to develop programs to influence physician practice patterns. Responsibility for managing care is being contested by health plans, medical groups and hospitals, as each seeks to accrue the savings that can result from the more efficient delivery of care. To manage the financial and clinical risk, providers are aggressively consolidating and reorganizing. Most significant was the rapid formation of intermediary organizations, such as independent practice arrangements (IPAs), physician-hospital organizations (PHOs), or management services organizations (MSOs), for contracting with managed care organizations. CONCLUSIONS: Managed care appears to have only a modest effect on how healthcare organizations deliver medical care, despite the profound effect that managed care has on how providers are organized. Rather than improving the efficiency of healthcare organizations, provider efforts to build large systems and become indispensable to health plans are exacerbating problems of excess capacity. It is not clear if new organizational arrangements will help providers manage the changing incentives they face, or if their intent is to blunt the effects of the incentives by forming larger organizations to improve their bargaining power and resist change.

Community Health Services↗
PubMed2003

Wall Street comes to Washington: where is health care headed?

Although health care spending trends have slowed slightly, employers and consumers can expect another round of double-digit health insurance premium increases in 2004, according to a panel of market and health policy experts at the Center for Studying Health System Change's (HSC) eighth annual Wall Street roundtable. Firms will continue to shift costs to workers but are skeptical of new insurance products, including consumer-driven health plans and tiered provider networks. Most health plans are thriving as they continue to price products ahead of cost trends and gain administrative efficiencies. Many hospitals, facing revenue pressures from increasing competition from physician-owned specialty facilities, are continuing aggressive building campaigns, raising concerns about increased costs if they overshoot and add too much capacity. Efforts to revive the ailing Medicare managed care program face an uphill climb as Congress debates reforms as part of prescription drug legislation.

Economic Competition↗
PubMed2003

[From deintegration to professional reintegration following a sick leave from work for a mental health problem].

The aim of this study is to better understand the factors involved in the process of professional reintegration following an absence because of a mental health problems. The methodology is based on data collected from individual interviews with workers who were on a sick leave for reasons of mental health problems as certified by a medical diagnosis. The analysis of the path of people allows to better seize the articulation between events preceding the work interruption, the process of restoration of capacities and conditions favoring or hindering the return to work. This study allows to conceive the interruption of work and the process of restoration of capacities as a turning point between the process of deintegration and professional reintegration and build a model that encompasses the dynamic of the whole factors involved.

English Abstract↗
PubMed1998

[Spiral computer tomography in diagnosis of hepatic diseases].

Spiral computer tomography (SCT) is a new method of computer tomography by which, in contrast to conventional CT, the information about absorptional capacity of tissues is obtained without omission of images which makes it possible to build MPR and 3D of a very high quality. 205 patients with diseases of hepatopancreatoduodenal area were examined, in 189 patients the diagnosis being verified. Optimal technique of intravenous bolus contrasting in SCT was developed. Using various time interval between the start of the scanning and the beginning of infusion of contrast media, it is possible to obtain primary image of the arteries (arterial phase of contrasting, time of delay 18-25 sec.), the picture of veins and the image of saturation of hepatic parenchyma--(venous return phase, time of delay 60-80 sec.), to reveal characteristics of contrasting of the liver masses during delay (8-15 min) phase. The largest quantity of masses are revealed in arterial phase of contrasting. Specific features of contrasting in hemangiomas and malignant tumors of the liver has been revealed. Hemangiomas absorb contrast medium already at the early phase as hypercontrasted lacunas in an outlying areas, at a late phase they are hyperdenced in relation to hepatic parenchyma. Primary and metastatic tumors of the liver accumulate contrast medium in an early phase along the whole area and quickly lose contrast medium during parenchymal phase. The method of contrast intensification enables evaluation of interrelation between tumor and vessels, to determine passage of hepatic arteries and branches of portal and hepatic veins, to visualise choledochal duct, to determine the distance between hepatic and tumor surface, and to produce these data as a view of multiplanar and three-dimensional image (reconstruction). The effectiveness of obtained reconstructions in planning of the extent of surgical intervention is demonstrated.

Contrast Media↗