Patient-physician covenant Crawshaw, R; Rogers, D E; Pellegrino, E D ...
JAMA : the journal of the American Medical Association,
1995-May-17, Letnik:
273, Številka:
19
Journal Article
Healthy People is the nation's agenda for health promotion and disease prevention. The concept, first established in 1979 in a report prepared by the Office of the Surgeon General, has since been ...revised on a regular basis, and the fourth iteration, known as Healthy People 2010, will take the nation into the 21st century. Leading Health Indicators for Healthy People 2010: Final Report contains a number of recommendations and suggestions for the Department of Health and Human Services that address issues relevant to the composition of leading health indicator sets, data collection, data analysis, effective dissemination strategies, health disparities, and application of the indicators across multiple jurisdictional levels.
Continued globalization, vast amounts of accessible data on public platforms, and advances in technology are changing the complexity of competitive intelligence (CI) and presenting opportunities for ...experts with skills in this and associated fields and for organizations that utilize this expertise to create competitive advantage. Companies must develop robust decision-influencing functions with teams of experts that collectively integrate varying points of view and recommendations using systems thinking and design that result in synergistic integrated competitive intelligence or, as sometimes referred to, integrated intelligence capabilities. This Integrated Intelligence or Integrated Intelligence Synergy Model means that intelligence functionality and skills must include the methodical collective nature of all considerations about markets from a variety of intelligence pools, including economic, market, competitor, customer, and technological intelligence insights from the myriad of complex datasets that exist. This multifaceted intelligence viewpoint, conducted in partnership with other disciplines, is critical in solving issues and creating opportunity for any organization around the world that aims to be a leader.
This is the first part of an in-depth study focusing on medical liability and its effect on access to and delivery of obstetrical care.The book addresses such questions as:Do liability concerns ...impede the use of new technologies?Have liability issues affected the physician-patient relationship?Are community health and maternity centers being harmed?What specific remedies are being considered and what are their prospects for success?
With the PACS instrument on Herschel, 134 low mass members of the Taurus star-forming region spanning the M4-L0 spectral type range and covering the transition from low mass stars to brown dwarfs ...were observed. Combining the new Herschel results with other Herschel programs, a total of 150 of the 154 M4L0 Taurus members have observations, and we have added an additional 3 targets from Spitzer to form the 153object TBOSS (Taurus Boundary of Stellar/Substellar) sample, a 99% complete study. Finally, comparing the TBOSS results with a Herschel study of Ophiuchus brown dwarfs reveals a lower fraction of disks around the Taurus substellar population with flux densities comparable to the Ophiuchus disks.
Healing persons and therapeutic institutions Bulger, Roger J.
American journal of obstetrics and gynecology,
04/1999, Letnik:
180, Številka:
4
Journal Article, Conference Proceeding
Shenandoah National Park (SNP) receives more acid deposition than any other national park in the United States of America. As part of an effort to assess the impact of acidification upon fish in the ...park, in situ sub-lethal stress bioassays (measured by monitoring hematocrit) were conducted with acid sensitive blacknose dace Rhinichthys atratulus. Study streams experienced moderate acidification events that resulted in reduced pH (the largest reductionbeing 6.18 to 5.37) and increased total monomeric aluminum (TMA) concentration (the largest being 15 to 39 μg L^sup -1^). Although some of these acidification events were within the pH and TMA range expected to result in blacknose dace stress, none was detected by monitoring hematocrit. In an acid-sensitive stream, mean baseflow (pre-event) hematocrit ± SD, was 33.5±4.5%, and hematocrit during the largest event was 31.5±4.9%, A moderate acidification event also occurred in a less acid sensitive stream; pH dropped from 7.18 to 6.38 but TMA remained below 10 μg L^sup -1^. Mean hematocrit during baseflowin this stream was 32.3±2.8%, and hematocrit during event flow was 34.1±5.0%. At the time of this bioassay, acidificationevents that would result in acute toxicity for most species of fish did not occur, however the conditions documented in this investigation do not represent the most acute acidification events that have been observed in SNP. It should be noted that a chronic sub-lethal stress, measured by condition indices, has been observed among blacknose dace in SNP streams.PUBLICATION ABSTRACT
Decades of acid deposition in the Galloway area, southwestern Scotland, have resulted in acidification of surface waters and damage to fish. In the period since 1980, however, acidic deposition has ...decreased substantially. A survey of 50 lochs conducted in 1979 and repeated in 1988 reveals major changes in water chemistry over this 9 year period. Together these two data sets separated in time by 9 years and covering a period of relatively large and rapid change in acid deposition offer a valuable basis for the evaluation of acidification models. Concentrations of SO4 in the lochs were on the average 42% lower in 1988 relative to 1979. The decline is readily explained by the large and rapid decline in sulphate concentrations in precipitation in the area. Concentrations of non-marine base cations decreased from 155 to 90 microequiv l-1 and acid neutralising capacity (ANC) increased. The change in ANC was due mostly to decreased concentrations of Al. pH levels showed no systematic change from 1979 to 1988. The regional changes in water chemistry over the period 1979-1988 are corroborated by regular measurements at several of these lochs over this 9 year period. MAGIC (Model for Acidification of Groundwater In Catchments) successfully reproduces the major changes in water chemistry observed over the period 1979-1988. Both calibration to the 1979 data with prediction of 1988, and calibration to the 1988 with reconstruction of 1979 give close fits to the observations. The model provides a means by which the future impact of acidic deposition and afforestation can be evaluated. A fish response function coupled to MAGIC provides the basis for evaluation of past and future fish status in the region. MAGIC predictions under different acid deposition and forestry scenarios indicate that if acidic deposition is held constant at 1988 levels, afforestation causes further acidification of the lochs. Acidic deposition emerges as the major cause of soil and water acidification in the Galloway region, although forestry practices can exacerbate the effects.
AimEarly specialist assessment of Transient Ischaemic Attack (TIA) can reduce the risk of stroke and death. We assessed feasibility of undertaking a multi-centre cluster randomised trial to evaluate ...clinical and cost effectiveness of referral of patients attended by emergency ambulance paramedic with low-risk TIA directly to specialist TIA clinic for early review.MethodWe randomly allocated volunteer paramedics to intervention or control group. Intervention paramedics were trained to deliver the intervention during the patient recruitment period. Control paramedics continued to deliver care as usual. Patients with TIA were identified from hospital records.ResultsDevelopment and recruitment phases are complete, with outcome follow up ongoing. Eighty nine of 134 (66%) paramedics participated in TIER. Of 1377 patients attended by trial paramedics during the patient recruitment period, 53 (3.8%) were identified as eligible for trial inclusion. Three of 36 (8%) patients attended by intervention paramedics were referred to the TIA clinic. Of the others, only one appeared to be a missed referral; in one case there was no prehospital record of TIA; one was attended by a paramedic who was not TIER trained; one patient record was missing; all others were recorded with contraindications: FAST positive (n=13); ABCD2 score >3 (n=5); already taking warfarin (n=2); crescendo TIA (n=1) other clinical factors (n=8).ConclusionPreliminary results indicate challenges in recruitment and low referral rates. Further analyses will focus on whether progression criteria for a definitive trial were met, and clinical outcomes from this feasibility trial.Conflict of interestNoneFundingNone
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