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PubMed2004

Current status of water reuse systems in Korea.

In Korea, the current water resources will fall short by 2.6 billion tons to meet the 38 billion ton water demand in the year 2020. To overcome the future water shortage, it is desirable to minimize water consumption and to reuse treated wastewater. There are a total of 99 on-site water-recycling systems in the country. The potential capacity of the 99 systems is 429 thousands tons/day, which is 3.6% of the total service water. Compared to other industrialized countries, the number of the water recycling systems in Korea is extremely small. This is mainly due to the following reasons. First, in Korea, any building with more than 60,000 m2 of total floor space is required to install a water reuse system by law. However, only less than 0.5% of the total buildings have more than 10,000 m2. Therefore, the regulation is ineffective and merely nominal. Second, service water is supplied at low charge (0.20 US-dollar/m3 water). The inexpensive service water often discourages people to recycle treated wastewater. Third, people still think recycled water is not clean enough and can cause diseases. Therefore, they should be informed that a well-maintained recycling system does not fail to produce water with high quality.

Conservation of Natural Resources↗
PubMed1998

Networking via wireless bridge produces greater speed and flexibility, lowers cost.

Wireless computer networking. Computer connectivity is essential in today's high-tech health care industry. But telephone lines aren't fast enough, and high-speed connections like T-1 lines are costly. Read about an Ohio community hospital that installed a wireless network "bridge" to connect buildings that are miles apart, creating a reliable high-speed link that costs one-tenth of a T-1 line.

Computer Communication Networks↗
PubMed1980

Satellite laboratory services: a blending of form and function.

In March, 1980, Holzer Clinic, Ltd., a 45-physician multispecialty group practice located in southeastern Ohio, started its own clinic laboratory operation at a facility some four miles from the clinic building. To the clinic, this significant event signaled a major departure in operations, concept and philosophy.

Computers↗
PubMed2001

The potential role of the Australian Institute of Health and Welfare in a National Cardiac Surgery Database.

The Australian Institute of Health and Welfare has responsibility for developing national health information and collections and is thus a candidate for building and operating a National Cardiac Surgery Database. Many functional characteristics place the Institute in a favourable position for establishing and maintaining a national patient-based database of cardiac surgery. These include its experience in the field of database management, its record of objectivity and its capacity to provide data protection. In addition it has significant experience in monitoring cardiovascular diseases, their risk factors, treatments and outcomes through its National Centre for Monitoring Cardiovascular Disease. The Institute, a statutory body operating within the Federal Government's health portfolio, is independent of policy, administrative and regulatory functions within that portfolio. The health-related databases managed by the Institute include those that record national statistics on insulin-treated diabetes, hospital separations, cancer and death. The Institute also maintains, on behalf of the National Heart Foundation, a cardiac surgery register based on aggregated data from cardiac units. This register is not patient based as the new database would be. With this range of experience, the Institute sees itself well placed to contribute to the development of this important project.

Journal Article↗
PubMedDate not supplied

Animated simulation: a valuable decision support tool for practice improvement.

Animated computer simulation is a powerful tool for healthcare operation improvement. As a decision support tool, it offers a systematic method to compare alternative approaches to healthcare operations. Because staff interaction is encouraged by this tool, simulation projects facilitate staff team building and process change ownership. Information that is not used as applied knowledge for the purpose of improvement is worthless. Simulation offers management detailed knowledge of processes, enabling management to make better-informed decisions by providing performance data, such as resource usage rates, patient wait times, capacity rates, and process performance information. Alternatives under consideration can be compared and modified without high financial, personal, and customer costs to the healthcare operation. The knowledge gained from each alternative's simulation response variables can be evaluated against set criteria, the status quo, and each other to determine the best option. Current automation systems and software products allow decision makers to use this tool without investing resources in errant options. A simulation project strategy with examples and a case study of change and renovation of a family practice clinic are provided.

Community Health Services↗
PubMedDate not supplied

Technical needs assessment: UWMC's sensitivity analysis guides decision-making.

In today's healthcare market, it is critical for provider institutions to offer the latest and best technological services while remaining fiscally sound. In academic practices, like the University of Washington Medical Center (UWMC), there are the added responsibilities of teaching and research that require a high-tech environment to thrive. These conditions and needs require extensive analysis of not only what equipment to buy, but also when and how it should be acquired. In an organization like the UWMC, which has strategically positioned itself for growth, it is useful to build a sensitivity analysis based on the strategic plan. A common forecasting tool, the sensitivity analysis lays out existing and projected business operations with volume assumptions displayed in layers. Each layer of current and projected activity is plotted over time and placed against a background depicting the capacity of the key modality. Key elements of a sensitivity analysis include necessity, economic assessment, performance, compatibility, reliability, service and training. There are two major triggers that cause us to consider the purchase of new imaging equipment and that determine how to evaluate the equipment we buy. One trigger revolves around our ability to serve patients by seeing them on a timely basis. If we find a significant gap between demand and our capacity to meet it, or anticipate a greater increased demand based upon trends, we begin to consider enhancing that capacity. A second trigger is the release of a breakthrough or substantially improved technology that will clearly have a positive impact on clinical efficacy and efficiency, thereby benefiting the patient. Especially in radiology departments, where many technologies require large expenditures, it is no longer acceptable simply to spend on new and improved technologies. It is necessary to justify them as a strong investment in clinical management and efficacy. There is pressure to provide "proof" at the department level and beyond. By applying sensitivity analysis and other forecasting methods, we are able to spend our resources judiciously in order to get the equipment we need when we need it. This helps ensure that we have efficacious, efficient systems--and enough of them--so that our patients are examined on a timely basis and our clinics run smoothly. It also goes a long way toward making certain that the best equipment is available to our clinicians, researchers, students and patients alike.

Academic Medical Centers↗
PubMed2005

Managing rivers for fisheries and livelihoods: how can we do it better?

The growing attention being given to improving water productivity at the catchment level has given rise to increased interest in the contribution of aquatic ecosystems and in particular fisheries to reducing rural poverty and improving food security. There is growing recognition that these natural resources have an important role to play in pro-poor water management in many of the world's river basins, but that capacity to optimize these benefits is constrained by a lack of appropriate technologies and tools to do so. The present paper provides an overview of the current state of understanding of these issues and identifies a number of challenges to be addressed, namely the need to: (i) build wider understanding of the value of river fisheries; (ii) understand the water requirements for sustaining river fisheries; and (iii) develop governance arrangements that bring fisheries to the decision-making table. It concludes by distilling from recent reviews of river fisheries valuation, environmental flows, and governance, a set of specific directions that need to be taken in order to meet these challenges.

Conservation of Natural Resources↗
PubMed1982

Philosophic considerations of quality of life for the disabled.

All of us are concerned not only about the length of our lives but also about having meaningful lives. The quality of living rather than longevity is the significant consideration. For all of us a certain level of physical and material well-being, safety, and health is necessary as the basis for a satisfying life. However, that level is only the physical foundation on which we build the meaningful relationships, the social interaction, and the personal participation that provide the same fulfillment that is the epitome of quality of life. The disabled patient has a greater problem in achieving a satisfactory quality of life. He has lost, or possibly never had, the physical capacity for the necessary responses to establish and maintain the relationships, interactions, and participation that healthy persons have. As a consequence he is dependent upon the rehabilitation team to provide assistance and services to make it possible for him to achieve his optimal level of performance as the basis for the quality of his life.

Persons with Disabilities↗
PubMed1981

[Immediate effects of intravenous acetazolamide on intracranial pressure (author's transl)].

Nineteen patients with hydrocephalus or head injury were subjected to a continuous intraventricular pressure monitoring and received acetazolamide. Seven mg per Kg body-weight were infused intravenously in one minute. Three patterns of reactions were recorded: 1. a sharp and large rise in cerebrospinal fluid pressure 2. a moderate rise 3. no significant change in C.S.F. pressure. The mechanisms of these responses are investigated: metabolic CO2, which is normally converted rapidly to HCO3- through mediation of carbonic anhydrase within erythrocytes, builds up to produce an immediate effect of cerebral vasodilatation and increases C.S.F. pressure of patients with disturbed compensatory mechanisms. Intravenous acetazolamide may be used as a functional test in patients with ventricular enlargement and normal intracranial pressure. This technique provides useful data about the remaining compensatory capacity for further increases in intracranial volume.

Acetazolamide↗
PubMed1993

Recent developments in alcoholism:psychodynamic approaches.

A review of the substance abuse literature in the 1980s focuses on deficits in self-regulating capacities, in self-care functions, and in other vulnerabilities of the self, such as an inappropriate use of defenses and problems in intimacy. Various models which attempt to explain these behaviors are described, as well as techniques of dynamic psychotherapy for substance abuse, which emphasize the building of ego functions and the internalization of self-preservation functions. Commonalities and differences of substance abuse with other intensely driven compulsive behaviors (e.g., pathological gambling or certain sexual behaviors) are also considered.

Alcoholism↗
PubMed1986

The proper contributions of social workers in health practice.

Current and potential future contributions of social workers to health practice are considered at the three levels of direct service to patients, influence on the processes and procedures of the health setting and influence on its future planning and service development. The capacity of U.S.A. and U.K. social work to contribute at these levels is compared in the light of their contrasting relationships to the health system. U.S.A. social work in health care is practised as employees of the health setting or as private practitioners and contains the majority of U.S.A. social workers. It remains a specialism that sustains a major body of published work, commitment to knowledge-building, standard setting and performance review, and a psycho-social orientation shared by a growing number of medical and nursing professionals. Its approach to the health system is that of the pursuit of professional credibility in the secondary setting by adopting the professional-technical practice model of the clinician. U.K. social work since the early 1970s has been committed to generic education and practice and to the development of its own primary setting in social services departments which now employ almost all U.K. social workers. Area team social work in these departments, typified by statutory work with the most deprived sections of the population, has become the dominant culture of British social work, with implications for the occupational identity and career prospects of those social workers who are outposted or attached to health settings but no longer employed by them. British social work and its management now approach the health system from a position of organizational independence which should strengthen their capacity to influence the health system. The cultural differences between social work and medicine, however, are experienced more keenly than ever as many social workers adopt a socio-political practice model that is at odds with the professional-technical model of the clinician. Provision of social work services to the health system has become a questionable priority and raises the issue of whether much of what is now termed "health care' could more appropriately be termed "social care' and provided in a primary social work setting to which medicine and nursing would make their "proper contributions'.

Counseling↗
PubMed2005

beta-Sulfonamido gonadotropin-releasing hormone analogs: synthesis and evaluation of several parent hormone properties.

With the aim of producing long-acting analogs of gonadotropin releasing hormone (GnRH), four analogs, containing -X(6) (aa)psi(CH(2)SO(2)NH)-Leu(7) building unit (X(aa)=Gly, Ala, Val or Phe), and a reduced-size analog [Des-Tyr(5)]-GnRH which includes the unit Phe(5)psi(CH(2)SO(2)NH)-Leu(6), and [beta-Ala(6)]-GnRH were synthesized. The peptides were evaluated for their capacity to induce LH-release from rat pituitary cells and to withstand proteolysis by pituitary-derived enzymes, compared with the parent peptide GnRH. Albeit stable toward enzymatic degradation, the sulfonamido containing peptides were only marginally bioactive. [beta-Ala(6)]-GnRH, however, induced LH-release and bound to pituitary receptors nearly as efficiently as GnRH. This analog was also highly stable toward proteolysis suggesting that it may serve as a long-acting GnRH-analog.

Animals↗
PubMed2005

A new method to measure air-borne pyrogens based on human whole blood cytokine response.

Air-borne microorganisms, as well as their fragments and components, are increasingly recognized to be associated with pulmonary diseases, e.g. organic dust toxic syndrome, humidifier lung, building-related illness, "Monday sickness." We have previously described and validated a new method for the detection of pyrogenic (fever-inducing) microbial contaminations in injectable drugs, based on the inflammatory reaction of human blood to pyrogens. We have now adapted this test to evaluate the total inflammatory capacity of air samples. Air was drawn onto PTFE membrane filters, which were incubated with human whole blood from healthy volunteers inside the collection device. Cytokine release was measured by ELISA. The test detects endotoxins and non-endotoxins, such as fungal spores, Gram-positive bacteria and their lipoteichoic acid moiety and pyrogenic dust particles with high sensitivity, thus reflecting the total inflammatory capacity of a sample. When air from different surroundings such as working environments and animal housing was assayed, the method yielded reproducible data which correlated with other parameters of microbial burden tested. We further developed a standard material for quantification and showed that this assay can be performed with cryopreserved as well as fresh blood. The method offers a test to measure the integral inflammatory capacity of air-borne microbial contaminations relevant to humans. It could thus be employed to assess air quality in different living and work environments.

Air Microbiology↗
PubMed2004

Expression of AML1-ETO in human myelomonocytic cells selectively inhibits granulocytic differentiation and promotes their self-renewal.

The t(8;21) translocation is one of the most frequent translocations in acute myeloid leukaemia (AML), giving rise to the AML1-ETO fusion protein (or RUNX1-CBF2T1). This abnormality is associated with myelocytic leukaemia with dysplastic granulopoiesis. Here, we demonstrate that when expressed in a normal human (CD34(+)) progenitor population, AML1-ETO selectively inhibits granulocyte colony formation but not monocyte colony formation. In bulk liquid culture, we found that though AML1-ETO transiently inhibited the proliferation of CD34(+) cells, it promoted long-term growth of myeloid cells for more than 80 days, suggesting that differentiation was inhibited. In support of this, cultures expressing AML1-ETO demonstrated enhanced retention of colony-forming capacity. Phenotypic examination of AML1-ETO cultures revealed a defect in granulocytic differentiation in terms of retention of CD34(+) cells within the culture and delayed CD11b upregulation. Morphologically, granulocyte terminal differentiation in AML1-ETO-expressing cells was inhibited by 83+/-5%, giving rise to a build-up of early to intermediate granulocytes that exhibited a number of morphological features associated with t(8;21) leukaemias. In contrast, AML1-ETO had little or no effect on monocytic differentiation. Taken together, these results suggest that expression of AML1-ETO selectively inhibits the differentiation of granulocytic cells and promoted extensive self-renewal, supporting a causal role for t(8;21) translocations in leukaemogenesis.

Antigens, CD34↗
PubMed2006

Cryoelectron microscopy and EPR analysis of engineered symmetric and polydisperse Hsp16.5 assemblies reveals determinants of polydispersity and substrate binding.

We have identified sequence and structural determinants of oligomer size, symmetry, and polydispersity in the small heat shock protein super family. Using an insertion mutagenesis strategy that mimics evolutionary sequence divergence, we induced the ordered oligomer of Methanococcus jannaschii Hsp16.5 to transition to either expanded symmetric or polydisperse assemblies. A hybrid approach combining spin labeling EPR and cryoelectron microscopy imaging at 10A resolution reveals that the underlying plasticity is mediated by a packing interface with minimal contacts and a flexible C-terminal tether between dimers. Twenty-four dimeric building blocks related by octahedral symmetry assemble into the expanded symmetric oligomer. In contrast, the polydisperse variant has an ordered dimeric building block that heterogeneously packs to yield oligomers of various sizes. Increased exposure of the N-terminal region in the Hsp16.5 variants correlates with enhanced binding to destabilized mutants of T4 lysozyme, whereas deletion of this region reduces binding. Transition to larger intermediates with enhanced substrate binding capacity has been observed in other small heat shock proteins including lens alpha-crystallin mutants linked to congenital cataract. Together, these results provide a mechanistic perspective on substrate recognition and binding by the small heat shock protein superfamily.

Archaeal Proteins↗
PubMed1998

Engineering mammalian chromosomes.

Construction of a mammalian artificial chromosome (MAC) will develop our understanding of the requirements for normal chromosome maintenance, replication and segregation while offering the capacity for introducing genes into cells. Construction of MACs with telomere, centromere and replication function has been approached by two methods. The 'top down' strategy uses artificially induced chromosome truncations as a means to define a minimal chromosome that retains the mitotic properties of a normal chromosome. The 'build up' approach has focused on attempts to assemble MAC vectors containing functionally defined telomere repeats together with candidate centromere and replication origin sequences. Here we report on significant advances in both areas, with particular emphasis on two reports showing that stable, low copy number MACs containing a functional centromere can be produced following transfection of naked DNA into the human HT1080 cell line. One approach used a transfection mixture of cloned synthetic alpha-satellite arrays up to 1 Mb in length and unlinked telomeric DNA, in either the presence or absence of random human genomic DNA fragments. In the second approach, MACs were formed from a defined yeast artificial chromosome (YAC) DNA molecule containing 100 kb of highly homo- geneous alphoid DNA retrofitted with human telomere repeats. These results demonstrate for the first time that alpha-satellite DNA can seed de novo centromeres in human cells, indicating that this repetitive sequence family plays an important role in centromere function. The stability of these MACs suggests that they have potential to be developed as gene delivery vectors.

Animals↗
PubMedDate not supplied

Public health infrastructure system change: outcomes from the turning point initiative.

The Robert Wood Johnson and W.K. Kellogg Foundations created the Turning Point initiative to transform and strengthen the public health infrastructure. This study examined 135 public health system changes for their links to multiple sector collaborative engagement, essential public health services, health outcomes, and infrastructure building strategies. An on-line documentation system developed by the University of Kansas was used to record and analyze these linkages. The results showed that each state accomplished notable system changes; the majority involved more than one sector and primarily related to increasing local public health system capacity and organizational change.

Cooperative Behavior↗