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By marrying the strategic functions of the planning, marketing and information services departments at the senior administrative level, leaders at Children's Hospital in Columbus are able to build a more accurate and useful picture of their market, and they can better coordinate their approaches to it.
To plan an I/S strategy without sufficient communications capabilities omits a vital link to success. At Lehigh Valley Hospital in Allentown, Pa., information services experts are building a network foundation to support today's strategic plan as well as tomorrow's technology.
In the search for cost efficiency, psychiatric patients are experiencing greater restrictions on their insurance benefits. Managed psychiatric care may provide a useful alternative to arbitrary benefit limits, but may also interfere with treatment, especially if there is a disagreement between the manager and the responsible clinician. Three clinical vignettes are presented and the implications of possible premature discharge described as a first step in building a research agenda on the clinical consequences of managed psychiatric care.
The construction management approach enables the owner to be involved in the building project from the initial design stage through project completion. He participates in cost-benefit decisions, helping to ensure that the best possible building is constructed at the lowest possible cost.
In previous studies, thermodynamic dissection of the dimerization interface in CA-C, the C-terminal domain of the capsid protein of human immunodeficiency virus type 1, revealed that individual mutation to alanine of Ser178, Glu180, Glu187 or Gln192 led to significant increases in dimerization affinity. Four related aspects derived from this observation have been now addressed, and the results can be summarized as follows: (i) thermodynamic analyses indicate the presence of an intersubunit electrostatic repulsion between both Glu180 residues. (ii) The mutation Glu180 to Ala was detected in nearly all type 2 human immunodeficiency virus variants, and in several simian immunodeficiency viruses analyzed. However, this mutation was strictly co-variant with mutations Ser178Asp in a neighboring residue, and Glu187Gln. Thermodynamic analysis of multiple mutants showed that Ser178Asp compensated, alone or together with Glu187Gln, the increase in affinity caused by the mutation Glu180Ala, and restored a lower dimerization affinity. (iii) The increase in the affinity constant caused by the multiple mutation to Ala of Ser178, Glu180, Glu187 and Gln192 was more than one order of magnitude lower than predicted if additivity were present, despite the fact that the 178/180 pair and the two other residues were located more than 10A apart. (iv) Mutations in CA-C that caused non-additive increases in dimerization affinity also caused a non-additive increase in the capacity of the isolated CA-C domain to inhibit the assembly of capsid-like HIV-1 particles in kinetic assays. In summary, the study of a protein-protein interface involved in the building of a viral capsid has revealed unusual features, including intersubunit electrostatic repulsions, co-variant, compensatory mutations that may evolutionarily preserve a low association constant, and long-range, large magnitude non-additive effects on association.
The highly complex practice of building successful community coalitions is explored. Key dimensions related to coalition success are identified and best practices are delineated. Nine dimensions are explored that are critical to coalition success: coalition readiness, intentionality, structure and organizational capacity, taking action, membership, leadership, dollars and resources, relationships, and technical assistance. Two coalition case studies follow the discussion of dimensions and illustrate the journey traveled to create successful community coalitions.
In the first stage of the application of behavioral methods the improvement of the level of function in the social environment was in the lime-light. In the single case the restoration of a structured daily routine represents the presupposition for a cognitive therapy. Its aim is the building up of intrapsychic controlling processes that support the structuring of embarrassing experiences. E.g., it is possible by controlled introspection to identify stressors, perceived by the patients themselves, leading to overstrain-reactions. The reduced capacity to be subjected to stress has to be made understandable to the patient who is encouraged to intentionally use avoiding reactions. By the insight in such connections the problem is comprehended and the anxiety reduced. In the psychoeducation the instruction of the family members about basic symptoms proved to be useful to put the behavior of the patients in the right place and to correct misunderstandings. A skeleton-concept is needed, containing many individual components that can be variably used. The completion of these components is the aim, because the very heterogeneous features of the residual syndromes of schizophrenic disorders require such an "open concept".
This paper considers the principal elements that underpin policy frameworks for supporting food security in protracted crisis contexts. It argues that maintaining the food entitlements of crisis-affected populations must extend beyond interventions to ensure immediate human survival. A 'policy gap' exists in that capacities for formulating policy responses to tackle the different dimensions of food insecurity in complex, fluid crisis situations tend to be weak. As a result, standardised, short-term intervention designs are created that fall short of meeting the priority needs of affected populations in the short and long term and only partially exploit the range of policy options available. The paper discusses key attributes of agency frameworks that could support more effective policy processes to address longer term as well as immediate food security needs. Additionally, it points to some main challenges likely to be encountered in developing such frameworks and, with the participation of beneficiaries, translating them into effective action.
From a global perspective, large disparities persist between the focus of health research investments and the global burden of illness. Over the past four years, Canadian efforts to address these disparities have steadily increased. The objectives of this paper are to present these recent achievements and to highlight continuing challenges. We summarize the activities of two complementary Canadian initiatives, both aimed at increasing Canada's investment and involvement in global health research. They are the Global Health Research Initiative--a partnership involving four federal agencies; and the Canadian Coalition for Global Health Research--a not-for-profit membership organization. Several achievements include: increased investment in global health research; increased knowledge production and use through "South-Canada" partnerships; stronger advocacy and increased awareness; enhanced capacity development; and improved coordination and communication. Based on these achievements, important current and future challenges are identified. They include: more coherent resource allocation; more focussed health research priorities; and the need to maintain and build momentum.
The new national hospital, "Rikshospitalet", is to be built in the northwestern part of Oslo in 1993. It is not only words when the planners talks about humane architecture. The national hospital is a training hospital for Oslo university, and the various consequent functions are arranged according to a logical plan. The most important feature of the hospital is its main "street", an open construction under a glass roof. It will bustle with life, since it will house both public services and outpatient reception. The street delimits different zones, with causal traffic at street level and hospital traffic between the wards and operating theatres and X-ray departments (which are collected in blocks in a central square) on gangways crossing the "street" at higher levels. The wards are formed as pavillions which project from the main building. In this way each ward will be of reasonable size, and the patients will be in close contact with the beautiful surroundings. The hospital will cover about 120,000 square meters, and its estimated capacity is 25,000 in-bed patients and 100,000 outpatient consultations per year.
The goal of this study was to confirm the capacity of occupational medicine to become involved in cooperative screening programs with a dosage of the PSA (Prostate Specific Antigen) determined by immunoradiometric assay. Two thousands and five hundred seventy three salaried workers in the building sector, between 50 and 65 years old, participated in this investigation. Thirty seven individual ie 1.4% had a PSA level above or equal to 10 micrograms/l. Among them, 35 were checked within three months and 17 were found to have a persistently elevated PSA level. In this subgroup 15 pathologies including two cancers were found. We observed a great variability in the results of PSA determination in the groups of individuals whose initial assay level was above or equal to 10 micrograms/l. The linear correlation coefficient between the two assays (on the same individual), carried out at a six week interval on average, was low (r = 0.52 for N = 35). In our series, 3.5% of patients followed up had undergone a rectal examination less than a year previously. Occupational medicine seems to be an efficient setting for screening intervention. However, the people mainly concerned by our study, (salaried workers seen through the physicians interviewed) did not seem very aware of this type of action.
This article examines strategies and methodologic issues for researchers to consider when conducting community-based research within a racial/ethnic minority community. Members of minority communities have considerable skepticism about the health care system and researchers who work under its auspices. To facilitate quality research, it is necessary to build a mutually beneficial partnership between the community and researchers. Suggested strategies for accomplishing this goal, such as seeking out information on the social and political forces shaping the community and developing the community's capacity to undertake research of this type, are described. Methodologic issues include the importance of community input in defining the minority population group and its leadership, the benefits and limitations of conducting comparative analysis, and the need for measurement tools and techniques that are culturally and socially appropriate. Minority and nonminority researchers must make a concerted effort to gain knowledge of and respect for a community whose culture, values, and beliefs may differ from their own.
OBJECTIVE: To determine whether the respiratory burst of neutrophils from bovine blood and milk can be analyzed by use of a fluorometric resazurin reduction assay. SAMPLE POPULATION: Neutrophils were obtained from EDTA-anticoagulated blood of 7 dairy cows. Neutrophils also were isolated from milk samples of a cow intramammarily challenge exposed with Escherichia coli lipopolysaccharide. PROCEDURE: The respiratory burst of neutrophils was analyzed in parallel, using the conventional luminol-enhanced luminometric procedure and a novel fluorometric procedure with resazurin as the fluorogenic substrate. Opsonized zymosan and phorbol myristate acetate were used as stimulants. The mechanism of the fluorescent response was analyzed, using metabolic inhibitors to various cell functions. Luminometry and fluorometry were carried out in parallel, using microtitration tray-reading instruments. RESULTS: Stimulation of neutrophils induced resazurin reduction to resorufin and a fluorescent response. The luminescent response was transient, but the fluorescent response (build-up of fluorescent resorufin) was cumulative. Therefore, a single end-point measurement can be used for the fluorometric assay. CONCLUSIONS: The proposed fluorometric microtitration tray technology is simple and has a high throughput capacity. The fluorometric and luminometric assays seem to have similar potential in the analysis of phagocyte functions.
/ The number of visits to outdoor recreation areas has increased dramatically in the last three decades, leading managers and researchers to wonder if there is a limit to the amount of use a resource such as a park can accommodate. One of the difficulties in addressing this carrying capacity-related question has been the complex nature of visitor travel patterns on often extensive networks of roads and trails. Systematic direct observation is often impractical and anecdotal information is usually inadequate. This study explores the utility of computer simulation as a tool for describing visitor travel by building a dynamic model of visitor travel on the carriage roads of Acadia National Park, Maine, USA. The simulation model uses empirical inputs such as travel routes and travel speeds to generate simulated recreation days on the carriage roads. Data on persons-per-viewscape (PPV) conditions were then gathered from multiple model runs and incorporated into the National Park Service's visitor experience and resource protection (VERP) planning process. Results show that PPV conditions under present-day use levels do not violate proposed standards of quality. Results also show likely PPV conditions under scenarios of increasing use and in different areas within the carriage road system. Goodness-of-fit validity tests indicate the model is an accurate representation of the actual system. The findings of this study suggest that computer simulation is useful for estimating current carrying capacity conditions, predicting future conditions, and guiding related research. KEY WORDS: Computer simulation modeling; Carrying capacity; Recreation management; Acadia National Park
The pharmaceutical domain represents a type of internationalised policy network theorised in recent writings on neo-liberalism, neo-corporatism and governance. This article presents an analysis of developments in prescription drug regulation in Australia. A relatively stable, state-managed pattern of interaction has been superseded by less closed exchange, and the government itself has fragmented into agencies pursuing different objectives. Developments in the three core regulatory areas are described: safety and efficacy controls, social policy (access and equity), and state support for industry (economic) development. Consensus-building occurs within the context of the National Medicines Policy. The pharmaceutical industry, represented by Medicines Australia, has a stake in all aspects of pharmaceutical policy and regulation, and draws upon unique resources (expertise and lobbying capacity). The context for the developments described is Australia's abandonment of a protectionist version of the Keynesian welfare national state in favour of the model of the competition state, which is oriented towards support for the growth of high technology industries such as pharmaceuticals, premised on partnerships with business.
In eukaryotic cells, G-protein-coupled receptors (GPCRs), non-transporting nutrient carrier homologues and active nutrient carriers have been recently shown to function as sensors that directly monitor the level of nutrients in the extracellular environment. The plasma membrane is not only the cellular boundary at which signalling molecules that govern metabolism and proliferation are detected, but also the boundary across which nutrients that sustain the generation of energy and building blocks are transported. Nutrient sensors combine these functions in various ways. Classical receptor proteins detect the presence of nutrients, carriers combine the functions of nutrient transporters and receptors, and carrier homologues have lost their transport capacity and become pure receptors. The activation of signal transduction pathways by nutrients adds a new layer to the regulatory network that controls metabolism and proliferation. Nutrient sensors highlight the importance of both nutrients as signalling molecules and nutrient carriers as receptors for signalling pathways.
Grady Memorial Hospital in Atlanta has opened a new emergency-care center, designed around a fast-track system. It's only part of a massive $318 million renovation affecting nearly every department in the public hospital. When the project is completed in 1995, it will allow Grady to meet building codes, increase its total number of beds to 1,024 and eliminate duplicative services.
Although most companies dedicate considerable time and attention to acquiring and creating businesses, few devote much effort to divestitures. But regularly divesting businesses--even good, healthy ones--ensures that remaining units reach their potential and that the overall company grows stronger. Drawing on extensive research into corporate performance over the last decade, McKinsey consultants Lee Dranikoff, Tim Koller, and Antoon Schneider show that an active divestiture strategy is essential to a corporation's long-term health and profitability. In particular, they say that companies that actively manage their businesses through acquisitions and divestitures create substantially more shareholder value than those that passively hold on to their businesses. Therefore, companies should avoid making divestitures only in response to pressure and instead make them part of a well-thought-out strategy. This article presents a five-step process for doing just that: prepare the organization, identify the best candidates for divestiture, execute the best deal, communicate the decision, and create new businesses. As the fifth step suggests, divestiture is not an end in itself. Rather, it is a means to a larger end: building a company that can grow and prosper over the long haul. Wise executives divest so that they can create new businesses and expand existing ones. All of the funds, management time, and support-function capacity that a divestiture frees up should therefore be reinvested in creating shareholder value. In some cases, this will mean returning money to shareholders. But more likely than not, it will mean investing in attractive growth opportunities. In companies as in the marketplace, creation and destruction go hand in hand; neither flourishes without the other.