bluuebunny/crossref_metadata_2025_split huggingface dataset:
Semi‐automated system for measurement of nuchal translucency thickness
Authors: Moratalla J. , Pintoffl K. , Minekawa R. , Lachmann R. , Wright D. , Nicolaides K. H. 
Published: July 2010

AbstractObjectiveTo estimate intersonographer and intrasonographer variance components of fetal nuchal translucency (NT) thickness measurement using the traditional manual approach and a new semi‐automated system.MethodsA semi‐automated method was developed for measurement of the NT. In this method, the operator places an adjustable box over the relevant area at the back of the fetal neck. The system draws a line through the center of the nuchal membrane and another line at the edge of the soft tissue overlying the cervical spine. The system then identifies the largest vertical distance between the two lines. The images of 12 fetuses at 11–13 weeks of gestation satisfying the guidelines of The Fetal Medicine Foundation for measurement of NT were selected. They were exported in DICOM format from the ultrasound system, and four versions of each image were stored under different names. The resulting 48 images were presented in random order for electronic assessment. A total of 20 sonographers measured the NT in each set of 48 pictures, twice using the semi‐automated system and twice using the manual system, according to a randomized block design. Within‐ and between‐operator variance components were estimated. Relative biases were assessed by comparing the means from the two methods.ResultsThe estimated between‐operator SD using the semi‐automated method was 0.0149 mm compared with 0.109 mm for the manual method. The respective within‐operator SD values were 0.05 mm and 0.126 mm. The intraclass correlation coefficients for different sonographers measuring the same images were 0.98 and 0.85 for the semi‐automated method and the manual method, respectively.ConclusionThe measurement of fetal NT is more reliable when a semi‐automatic approach is used rather than the traditional manual method. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
Longitudinal changes in uterine, umbilical and fetal cerebral Doppler indices in late‐onset small‐for‐gestational age fetuses
Authors: Oros D. , Figueras F. , Cruz‐Martinez R. , Meler E. , Munmany M. , Gratacos E. 
Published: July 2010

AbstractObjectivesTo determine the longitudinal trends and rates of conversion of normal to abnormal uterine (UtA), umbilical (UA) and middle cerebral artery (MCA) Doppler velocimetry throughout the third trimester in late‐onset small‐for‐gestational‐age (SGA) fetuses.MethodsUtA, UA and MCA Doppler velocimetry was serially performed in a cohort of singleton consecutive late‐onset SGA fetuses with normal Doppler values at diagnosis. The rate of conversion of normal to abnormal Doppler values was evaluated by survival analysis. Longitudinal trends were modeled by means of multilevel analysis.ResultsA total of 616 scans were performed on 171 SGA fetuses. Mean gestational age at inclusion and at delivery was 34.1 (SD 1.6) and 38.7 (SD 1.7) weeks, respectively. The proportions of abnormal UtA (2.3 vs. 4.1%) and UA (2.3 vs. 2.9%) pulsatility index (PI) were not significantly different between 37 weeks and before delivery. On the other hand, the proportions of abnormal MCA‐PI (4.1 vs. 13.5%) and cerebroplacental ratio (CPR) (7 vs. 22.8%) were significantly different between these two examinations. The remaining proportion of cases with normal UtA‐, UA‐ and MCA‐PIs and CPR at 40 weeks were 98.6, 94.5, 85 and 49.6%, respectively. Whereas a slight increasing trend was observed for the UtA‐PI (β = 0.002) and UA‐PI (β = 0.01), MCA‐PI (β = 0.044) and CPR (β = 0.124) showed a progressive decrease until delivery.ConclusionsLate‐onset SGA fetuses with normal Doppler velocimetry upon diagnosis show progression from 37 weeks' gestation with worsening CPR followed by a decrease in MCA‐PI. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
Implications of resting eggs of zooplankton for the paradox of enrichment
Authors: Nakazawa Takefumi , Kuwamura Masataka , Yamamura Norio 
Published: July 2010

AbstractIn this study, we numerically investigated to what extent introducing resting‐egg dynamics would stabilize simple Daphnia–algae consumer–resource models. In the models, the density of viable resting eggs was explicitly expressed, and we assumed that zooplankton produced resting eggs seasonally or in response to food deficiency and that resting eggs hatched seasonally. The models predicted that, although the paradox of enrichment was not completely resolved (i.e., the system was destabilized by eutrophication), we found the following conditions under which the stabilizing effects of resting eggs would be significantly large: (1) resting eggs are produced seasonally (rather than in response to food deficiency), (2) the annual average allocation ratio to resting eggs is large, and (3) the annual average hatching rate of resting eggs is low. The results suggest that resting‐egg dynamics can significantly reduce the paradox of enrichment within the biologically meaningful parameter space and contribute to the stability of plankton community dynamics.
Synthesis and Evaluation of a New Cationic Surfactant for Oil‐Well Drilling Fluid
Authors: Mahmoud Soad A. , Dardir Mona M. 
Published: July 2010

AbstractA new additive cationic surfactant for drilling fluid was synthesized by alkylation of coal tar phenol with tetradecyl alcohol; then, the alkyl phenol reacts with formaldehyde and amine to produce the Mannich base product. This product was reacted with sodium chloroacetate to produce the cationic surfactant; the structure of the synthesized surfactant was confirmed by FTIR analysis, evaluation of the prepared surfactant by surface properties such as surface tension, emulsification power, and wetting power. The prepared cationic surfactant showed good results when utilized in the formulation of both oil‐based mud and synthetic‐based mud as the primary emulsifier.
The impact of premenstrual dysphoric disorder among 92 bipolar patients
Authors: Fornaro M. , Perugi G. 
Published: July 2010

AbstractObjectivesTo evaluate the impact of Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV)-defined premenstrual dysphoric disorder (PMDD) lifetime co-morbidity among 92 bipolar patients.MethodNinety-two women with a lifetime diagnosis of DSM-IV-defined Bipolar Disorder (BD) either type I or type II were consecutively enrolled to determine co-morbidity rates with PMDD and associated clinical features. Measures included the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I) and the Clinical Global Impression (CGI) rating scale.ResultsIn our sample, 25 (27.2%) patients reported a lifetime history of PMDD according to DSM-IV criteria (PMDD+). PMDD+ reported higher rates of Cyclothymia and BP-II than PMDD− (respectively 72% vs. 36% and 88% vs. 60%). On the contrary, the carbohydrate-craving feature was more represented among PMDD− than PMDD+ (25% vs. 4%). PMDD was also significantly associated with post-partum depression (36% vs. 15%), Obsessive-Compulsive (24% vs. 7.5%) and Body Dysmorphic Disorders (24% vs. 6%). Finally, PMDD+ reported higher total number of Axis I co-morbid disorders than PMDD−.ConclusionsIn our cohort of BD women, PMDD is a frequent co-morbid condition, in particular among patients with BD-II or Cyclothymia. Multiple co-morbidities also represent a clinical variable associated with PMDD. Further perspective studies are necessary to better define the relationships between PMDD and BD.
Mensch und Körper im Museum: Das Deutsche Hygiene-Museum Dresden
Authors: Vogel Klaus 
Published: July 2010

Einleitung
Das Deutsche Hygiene-Museum Dresden, dessen Geschichte von tiefen Brüchen gekennzeichnet ist, hat mit der Entwicklung von einer Gesundheitseinrichtung zu einer Kulturinstitution gleichsam einen Perspektivwechsel auf die Themen Mensch und Körper vollzogen. Damit einher gingen eine Aufweitung des inhaltlichen Portfolios sowie ein Paradigmenwechsel in der Bildungs- und Vermittlungsarbeit.
Executive Briefing: Hospital Risk Management: The Second Decade
Authors: Keddy Wayne R. , Johnson Michael W. , McKerrow Wayne 
Published: July 2010

Risk management is defined as the systematic process of identifying, evaluating and addressing potential and actual risk. Although introduced to the hospital industry nearly a decade ago, its status in Canadian hospitals remains uncertain, a position that is in sharp contrast to the American situation. Chiefly as a result of the medical malpractice crisis and associated circumstances in the mid-1970s, risk management has emerged as an integral element in the operational activities of American hospitals. The process is a mechanism for self-protection in co-operative, self-insurance arrangements and to secure commercial premium adjustments. Many trends have been recognized in Canada that would suggest a predisposition toward the proliferation of risk management programs. These indicators include an increase in the number and size of claims against hospitals and physicians, a reduction in the availability of commercial health care insurance, and an increase in alternative insurance arrangements. Despite these indicators, movement toward risk management by Canadian hospitals has been minimal. A prime reason appears to be lack of financial incentives to stimulate the development of risk management programs. There is also an absence of specific accreditation standards pertaining to such programs. The case in support of risk management for Canadian hospitals continues to grow. The basic assumptions associated with a program are board, medical and staff support; a concerted effort to recognize and reduce potentially litigious situations and occurrences; and an ability to adapt. The initial steps to develop a risk management program include assessing current risk control activities and implementing structural elements. As well, a program must address its relationship to Quality Assurance activities in the hospital.
Continuum: Measuring and Managing the Patient Care Process
Authors: Collins Paul E. , Skafel Jon R. , Atkinson David I. , Jenkins Sandra 
Published: July 2010

The authors describe the CONTINUUM project which was initiated in a community hospital to manage the appropriateness, timeliness and acceptability of the patient care process on a concurrent or day-to-day basis. CONTINUUM is a quality and data-driven approach to continuous improvement of the patient care process. The St. Thomas-Elgin General Hospital researched “appropriateness of care” measurements and adapted their use for the CONTINUUM project. A concurrent care plan evaluation tool is applied to every care every day. This intensity of service (needs-based) strategy is called the ACTIVITY index. Patients are categorized ACTIV (appropriate) or non-ACTIV (perhaps inappropriate). Non-ACTIV patients are further subdivided into various “barriers to care,” from which service, hospital or physician-related factors can be stratified. Practice patterns and hospital resource use are then rapidly identified. The operational dimensions of the project (bedside, organization and community) are described as well as the inhibitors and enablers of this change process.
Governance of Hospitals in Canada: A Survey of Business Leaders Who Serve as Hospital Trustees
Authors: Brunelle Francis W.H. 
Published: July 2010

The Caldwell Partners Amrop International, in the course of conducting executive search, are often in contact with business executives across Canada, many of whom serve as hospital trustees. Because of the concerns being expressed informally by these trustees, it was decided to conduct a formal survey. The University of Toronto's Department of Health Administration was involved in designing the survey instrument and tabulating the results. The survey's findings cover many governance issues, such as board size, composition, terms, representation, roles, mergers, evaluation, quality of care, research institutes, fiscal issues and government relations.
Soutien émotionnel et formation lors d'une restructuration: Plus qu'un palliatif
Authors: Arndt Erika M. , Duchemin Kay F. 
Published: July 2010

Cet article illustre l'importance du soutien émotionnel et de la formation offerts aux patients, aux familles, au personnel et aux gestionnaires durant la restructuration entreprise au printemps de 1992 au Queen Elizabeth Hospital de Toronto. Le Queen Elizabeth Hospital est un établissement de 601 lits, réparti sur deux emplacements qui, tout en ayant vocation d'enseignement et de recherche, dispense des soins de réadaptation et d'entretien de pointe et met en oeuvre des programmes spécialisés de réadaptation médicale ainsi que des services gériatriques, de psychiatrie gériatrique et de soins prolongés. La restructuration s'est traduite par une réorganisation des services et la fermeture de 82 lits de long séjour, soit une unité de soins dans chacun des deux emplacements, pour compenser un déficit budgétaire escompté de 5,4 millions de dollars. Des restrictions internes n'ont pu ramener ce déficit qu'à 2,8 millions de dollars, rendant ainsi nécessaires des coupures additionnelles. L'article décrit les activités de soutien informelles et structurées qui ont eu lieu tout au long de cette transition qui a duré deux mois et évoque les sessions de formation dispensées sur une base régulière. Il accorde une attention particulière à la méthodologie et aux raison dictant cette action. Les auteures indiquent également des voies pour que le processus de rationalisation se déroule sans traumatisme.
Changing Perspectives on Hospital Governance
Authors: Chenoy Neville C. , Carlow Donald R. 
Published: July 2010

In the light of fundamental changes in the delivery of health and social services in Canada, hospital governance must be concerned with protection and enhancement of the organization on behalf of the owner (i.e., taxpayer) as well as accountability to the community it was established to serve. Based on a review of current literature, the authors suggest that the roles and responsibilities of a hospital board entail seven major activities: establish the mission, philosophy and future directions of the institution; choose and evaluate the chief executive officer; establish the ethical principles for the organization; ensure high quality care and services; attract resources to the institution and ensure their effective use; integrate the organization with its environment; and undertake its own self-evaluation, education and development. To play these roles effectively, hospital boards will need to develop more direct links with their communities and learn to share decision making with them.
The Attitudes of Ontario Hospitals toward Transitional Funding: Response to a Survey
Authors: Lave Judith R. , Jacobs Philip 
Published: July 2010

A survey of hospital administrators throughout Ontario was conducted to determine their views about the strengths and weaknesses of the new Transitional Funding system, especially as it existed between Phase One and Phase Two when many changes were taking place. The basic findings of the survey are presented. The authors go on to explore some of the answers and determine whether the hospital's reponses were influenced by their participation in the process and whether they were “winners” or “losers” as a result of the changes. This type of information should be useful to policy makers in Ontario as they modify the overall hospital financial system, and also be useful to policy makers outside the province who are contemplating making such changes.
Work Force Planning in the 90s, Part I: Efficiency, Economy and Political Will — The Need for a New Approach
Authors: Turner Linda A. , Østbye Truls , Pederson Linda L. 
Published: July 2010

Critical to health services management in today's economic climate is efficient utilization of our costly and sometimes limited supply of health care professionals. This two-part article gives an overview of current issues in health care work force planning in Canada. In Part I, the problems of estimating current supply are discussed. Needs-based and demand-based forecasting are contrasted. Comprehensive needs-based planning is recommended and changes needed in order to move toward this type of planning are discussed. In Part II, the maldistribution of health care professionals and various corrective measures within the context of needs-based comprehensive planning are discussed.
Patient-Focused Care: The Systemic Implications of Change
Authors: Jirsch Dennis 
Published: July 2010

Continuous quality improvement and customer identification have become pivotal concerns for modern management. It is evident that much past activity in health care has been narrowly focused, technologically based and of unknown efficiency. Identifying the patient as primary and overarching customer for health service organizations serves to simplify, refocus and redesign institutions so that resources and personnel are organized and allocated based on patient-care needs. Health care facilities can, accordingly, be ranked on the basis of their commitment and achievement with regard to patient-focused care. Quality becomes a matter of providing excellent and efficient medical care and satisfying the demands of the larger patient experience. Redefining the organization in the context of patient need profoundly changes the work place, creating less rigid, flattened organizational structures and emphasizing leadership rather than managerial activities.
Hospital Rightsizing: In Line with Long-Term Strategies and Economic Realities
Authors: Collins A.L. , Noble Ron 
Published: July 2010

After two years of difficult financial times, the Kitchener-Waterloo Hospital was faced with another upcoming year of tight fiscal constraint. In February 1991, the hospital implemented a program review process to align its services with the hospital's long-term strategy and economic realities. The authors present a thorough review of the literature pertaining to downsizing decisions. From a practical perspective they demonstrate a downsizing process, its implications and lessons to be learned so that a “rightsizing” exercise can be implemented to minimize the effects of the program and staff reductions while focusing on the positive long-term benefits of strategic planning. Although downsizing is a difficult process, the Kitchener-Waterloo Hospital was able to develop and implement a plan that minimized the impact on the hospital services and its staff. A reduction in expenses of over $2 million was achieved without having to lay off any permanent hospital staff. This was achieved by streamlining programs, reducing management supervisory positions and eliminating 50 full-time equivalent positions through attrition. Ultimately, the hospital's board, senior management, medical staff and employees felt that a rightsizing decision had been made, one which minimized the negative impact of restructuring on service delivery, hospital employees and the community served.
Optimalisation des hôpitaux: Conformité aux stratégies à long terme et aux réalités économiques
Authors: Collins A.L. , Noble Ron 
Published: July 2010

Après deux ans de difficultés financières, l'hôpital Kitchener-Waterloo entamait une autre année de sévères restrictions budgétaires. En février 1991, l'hôpital a mis en oeuvre un processus d'examen des programmes pour aligner ses services sur la stratégie à long terme de l'hôpital et les réalités économiques. Les auteurs présentent une étude exhaustive de la littérature traitant des décisions de compression. D'un point de vue pratique, ils illustrent un processus de compression, ses conséquences et les leçons à en tirer pour qu'un exercice d'«optimalisation» puisse être mis en oeuvre afin de minimiser les effets du programme et les réductions d'effectif, tout en mettant l'accent sur les avantages à long terme de la planification stratégique. Bien que la compression soit un processus difficile, l'hôpital Kitchener-Waterloo a réussi à élaborer et mettre en oeuvre un plan qui minimise son incidence sur les services hospitaliers et l'effectif. Sans avoir à mettre en disponibilité un seul employé permanent de l'hôpital, on a réussi à réduire les dépenses de plus de 2 millions de dollars. Grâce à des programmes de rationalisation, on a réussi à réduire les postes de cadres subalternes et éliminer 50 postes équivalents à plein temps au moyen de l'attrition. En définitive, le Conseil d'administration de l'hôpital, la haute direction, le personnel médical et les employés ont estimé qu'on avait pris une décision d'optimalisation qui minimisait les conséquences de la restructuration sur la prestation des services, sur les employés de l'hôpital et la collectivité desservie.
Paradigmes et gestion des soins infirmiers, analyse de la structure organisationnelle actuelle d'un grand hôpital
Authors: Wilson Donna 
Published: July 2010

Les hôpitaux se sont développés à une époque où le positivisme devenait une perception prédominante du monde. Le positivisme se fondait sur quatre tendances occidentales: prépondérance de la hiérarchie et de l'autocratie, expansion de la bureaucratie, application généralisée d'une orientation mécaniste au travail et prédominance de l'enquête «scientifique». La théorie organisationnelle s'est en grande partie développée à partir des constatations tirées des recherches quantitatives découlant d'une perception positiviste du monde. Nous présentons une étude de cas dans laquelle on analyse la structure organisationnelle actuelle des soins infirmiers d'un grand hôpital. On constate que la gestion des soins infirmiers repose sur un paradigme positiviste, à preuve la prédominance de l'orientation mécaniste et une structure autocratique et bureaucratique. On a fait l'essai d'un changement dont l'objet était de passer à la régie partagée, indice d'une évolution vers une structure organisationnelle plus moderne, reposant sur un paradigme différent. L'auteur termine en rappelant que les gestionnaires sont en grande partie responsables de la facilitation du changement, changement qui répondra aux besoins internes de ressources humaines et aux crises de rentabilité des hôpitaux actuels par une utilisation plus efficace des ressources humaines.
The Importance of Exterior Environment for Alzheimer Residents: Effective Care and Risk Management
Authors: Mooney Patrick , Nicell P. Lenore 
Published: July 2010

Evidence shows that environments especially designed for cognitively impaired seniors can maintain or increase their level of functioning. Little emphasis has so far been placed on the prosthetic role that may be played by exterior environments. This study attempted to determine the value that specially designed exterior spaces may have in reducing undesired behaviours, thereby minimizing risks to the patients and potential liability to the institution. The researchers tested that (a) poor environments increase residents' frustrations and can precipitate catastrophic behaviour and (b) freedom of movement and opportunities to avoid crowding, noise and excess stimulation minimize the frequency of aggressive behaviour. The researchers found that the use of exterior environments reduced incidents of aggressive behaviour, and contributed significantly to a risk management program.
A Specialized Home Care Team Does Make a Difference
Authors: Larson Dorothy , Odegard Ralph , Brown N.E. 
Published: July 2010

Results of a study done in a large teaching and research facility in Alberta reveal that a specialized home care team can substantially lower the cost of caring for people who are ventilator dependent. With the assistance of a pulmonary physician, the Respiratory Home Care program has shown excellent results. Patients report that they “feel as safe at home as in the hospital”, and the savings to the health care system are estimated to be about $2,000,000 per year.