bluuebunny/crossref_metadata_2025_split huggingface dataset:
Planning for Future Waste Management Operations in Developing Countries
Authors: Rushbrook P.E. , Finnecy E.E. 
Published: March 2008

The proper management of waste has several aspects: political, social, environmental, economic and technical. While the objectives of waste management policy differ little from country to country, the methods used to achieve them must be adapted to the prevailing circumstances in each. These factors include the availability of technical, economic, and human resources, and the competition that exists for them from other demands of national policy, especially in developing countries. There is no single correct method to achieve proper waste management. Nevertheless there are common needs that must be addressed by all nations that wish to manage their wastes better. These needs will include: adequate knowledge of the types of waste to be disposed of, how much there is, where it arises, who produces it, and what happens to it. It is also necessary to forecast how the present circumstances will change, and to identify appropriate methods to ensure that what should be done with waste is done. As forecasting the nature and quantity of waste that will arise in the future is difficult, an administrative mechanism is needed to ensure the regular supply of up-to-date data. In any city it is possible to equate the standard of waste management with the overall "standard of living" enjoyed by its inhabitants. Rising expectations of environmental improvement mean that disposal facilities must be appropriately designed, engineered and managed. They must also be planned for the future. The preparation of a thorough and effective plan is a lengthy task if done manually, and the discussion introduces the benefits that can be obtained from the use of computer models to assist, but not replace, human involvement in the preparation of a plan. Brief reference will be made to waste management models already used by waste managers to produce and update plans.
The Inspector General
Authors: Kusserow Richard P. 
Published: March 2008

The Congress has increasingly added responsibili ties and authorities to the Office of Inspector General in the Department of Health and Human Services. The Inspector General's responsibilities extend be yond oversight of the monies spent by the Medicare and Medicaid programs to the assurance of the quality of care rendered to beneficiaries. His quality assur ance mandate includes the imposition of sanctions against health care providers and practitioners who fail to meet new patient care obligations under Sec tion 1156 of the Social Security Act. The sanction processes followed by the peer review organizations (PROs) and the Inspector General have been subject to debate and change. Over the past year instructions and procedures have been strengthened by new PRO notice procedures, clearer instructions of PRO proceedings, and permitted use of expert wit nesses to provide evidence on cases in question. The Inspector General has received only 163 sanction recommendations from PROs from July 1985 through March 1988. Sixty-four physicians and one hospital have been excluded from the Medicare pro gram, and monetary penalties have been imposed on 25 physicians and 2 hospitals. Fifty-nine cases rec ommended for sanction have been rejected by the Inspector General. This article discusses the balancing of beneficiary and provider interests in the sanctions process and other quality assurance activities carried out by the Inspector General.
The Utilization Review Program
Authors: Castillo Jose J. , Bennett Kari E. 
Published: March 2008

The survival of a health care institution in today's economic climate is dependent on, among other things, the efficiency of its utilization review pro gram. The purpose of this article is to serve as a basic guideline for an institution to develop an adequate utilization review program. It emphasizes that a uti lization review program is essential for the economic survival of any health care industry. The utilization review program should be an integrated organization with the support of administration, and the partici pation of staff physicians, physician advisors, review nurses, and important hospital departments, such as social service, laboratory, medical records, preplan ning, and so forth. Following the format presented in this paper, an institution may easily develop a utili zation review program. The ideas presented in this paper have been time-proven at our institution. There must be educational programs for physicians on the basics of managing patients according to the prospective payment system and the economic impact physicians can make on the hospital's economic sta tus. These educational presentations must take place as often as necessary to reinforce policy and proce dure, and to carry out effective patient management. The utilization review department, as well as the medical staff, must work in close harmony with ad ministration to assist the facility in surviving trying economical times.
Quality Assurance and Utilization Review in a Health Insuring Organization
Authors: Nash David B. , Goldstein Philip , Kron Samuel 
Published: March 2008

HealthPASS is a Philadelphia-based health insur ance organization (HIO), owned and operated by the Penn Health Corporation, a subsidiary of Maxicare, the large for-profit health maintenance organization (HMO) company based in California. In a contractual agreement with the Pennsylvania Department of Public Welfare (DPW), Maxicare contracts primary care physician services on a capitated basis, and other services on a fee basis, to about 96,000 Medicaid enrollees in certain zip codes in Philadelphia. Al though HealthPASS does not provide care directly, it contracts with providers for these medical services. HealthPASS serves a primarily poor, minority, and inner city population with high rates of drug abuse, alcoholism, and mental illness. Currently, the enrol lees are served by a network of providers including more than 40 participating hospitals and over 500 primary care providers (PCPs) in the community. HealthPASS is unique as previous HIOs in Kentucky and Arizona both failed. This paper describes the quality assurance and uti lization review (QA-UR) system implemented by HealthPASS with specific examples of case discus sions and a detailed look at the structure and function of the internal review process. Before outlining the QA-UR system, a brief history is provided of the recent controversial trend toward managed care for Medicaid recipients, as there have been marked fail ures in this arena nationally. The HealthPASS system is described—what it is, how it is staffed, who it serves, and the health services it offers. Discussion of the QA-UR system follows. Lastly, some of the thorny political issues that remain, such as the effort by HealthPASS to educate physicians about managed care, to develop protocols of care, and to coordinate QA-UR for so many physicians and hospitals, are examined.
Assessing Peer Review in the Quest for Improved Medical Services
Authors: Hershey Nathan , Bontempo Lea C. 
Published: March 2008

The increased concern about the quality of medical services evidenced by, inter alia, the growing atten tion to quality of Peer Review Organizations. the purchasing and implementation of sophisticated med ical data systems by hospitals, and the growing clamor from private health insurers and employers about the rapidly rising costs of health services has made determining the effectiveness of medical inter ventions a priority subject for many authorities in the field of medical care assessment. At the risk of over simplification, the view that a greater focus on qual ity of health services is overdue has begun to energize healthcare institutions, the health professions, pay ers, and the general public. The objective of this paper and those that will fol low is to examine medical peer review. Medical peer review involves peer appraisal in at least two stages: in criteria and standard setting (1, 2), and in deter mining whether criteria and standards have been met by practitioners in the rendering of services (2). This first article describes some difficulties with the infor mation available to facilitate effective medical peer review, and examines the processes that provide the knowledge base upon which medical peer review de pends.
Conservative Management of Temporomandibular Joint Disease: A Case Study
Authors: Pfitzinger Walter R. 
Published: March 2008

Although temporomandibular joint (TMJ) prob lems are difficult to diagnose and evaluate, treatment today centers on conservative methods, not surgery. Many dentists lack the knowledge to adequately di agnose and treat TMJ, and many insurers as well as managed care plans have often refused to pay for conservative therapy, now known as Phase 1 TMJ treatment. This treatment consists of appliance or intraoral splint placement, along with physical ther apy. Ultimately, this therapy is far less expensive than either joint or orthognathic surgery. Since there is no recognized specialty in TMJ dis ease, managed care programs need to establish dis cernible criteria for the selection of providers to di agnose and treat their TMJ patients. By carefully selecting providers and monitoring the outcome of treatment rendered to patients, costs and time of treatment could be drastically reduced, benefiting the patient and the managed care program.
Assessing Peer Review in the Quest for Improved Medical Services and The Implications for Education in Quality Assessment: Part IV
Authors: Hershey Nathan 
Published: March 2008

Three court decisions reviewing medical peer re view conducted in hospitals were discussed at length in part III of this article. In their opinions the courts gave at least tacit approval to the procedures followed in the hospitals, and they accepted that an evidentiary basis for adverse action against the physicians was present. But not all medical peer review in hospitals resulting in adverse actions is found satisfactory when challenged in court, and the most prominent litigation in the decade of the 1980s concerning med ical peer review, Patrick v. Burget (1), is testimony to the potential for its perversion. Part II adverted to the potential for bias or lack of objectivity in assessing physician performance. Part I mentioned the problem of bias in the context of peer review of articles for publication and of research grant proposals. The objectives of Part IV are: (1) to examine the concern about bias in medical peer review and to indicate how it may be lessened, if not eliminated; (2) to address further the difficulty created by the rela tive lack of valid criteria to employ in medical peer review; (3) to review the extent of protection from liability afforded to participants in medical peer re view ; and (4) to describe the changes that should be anticipated in review of medical services in the fu ture. Before addressing these subjects it is essential to remind the reader that medical peer review is not conducted primarily for disciplinary purposes; rather, its purpose is to evaluate the quality of care. If the care is below the desired level, then steps to modify practitioner professional conduct by provid ing information about the effectiveness of diagnostic and therapeutic interventions, and imposing limits on practice if necessary, are warranted. Thus, while adverse credentialing decisions may follow medical peer review, they should not be viewed as its objec tive.
The Rational Ordering of Blood Cultures in the Emergency Department
Authors: Salluzzo Richard , Reilly Kevin 
Published: March 2008

A large number of patients with febrile illness are evaluated in emergency departments. Blood cultures are often obtained on such patients without reference to established guidelines. As a result of such practice, unnecessary blood cultures are being ordered with negative financial impact on both hospitals and pa tients. Generally speaking, as the number of blood cul tures obtained increases so does the number of false positive results. Follow-up on these results directly impacts on patient care as these patients are often subjected to call backs, additional work up, and ad mission to the hospital. This study reviews the manner in which blood cul tures were ordered before and after the introduction of general guidelines for their use. It outlines a proc ess whereby excessive ordering of blood cultures can be eliminated and suggests that this approach may be effective in limiting inappropriate use of other labo ratory and diagnostic studies.
Determining Medical Necessity of Outpatient Physical Therapy Services
Authors: Moorhead Joel F. , Clifford Joanne 
Published: March 2008

A patient referred for physical therapy may attend one or several therapy visits or may continue to re ceive ongoing therapy services several times weekly for several months. The question of the continued medical necessity of those services arises often. Determination of medical necessity for continued therapy services requires knowledge of the natural history of diseases that may require therapy services, familiarity with the effectiveness of treatment alter natives for those diseases, and awareness of commu nity practice patterns. Accurate and complete docu mentation from the therapist or referring physician is required for the physician advisor or utilization review consultant to make an accurate determination of medical necessity. A structured format for provid ing this documentation is suggested.
Appearance Retention of Carpets Using Image Analysis; Correlation with Subjective Method
Authors: Presley Ann Beth 
Published: March 2008

This study compares a new objective method for measuring texture retention in carpets to the usual subjective technique. The effect of mechanical wear on the texture of a range of nylon cut-pile carpets is examined using the image analysis techniques of covariance and co-occurrence analysis, and the results correlated with the subjective method. The image analysis methods provide reliable measurements of the retention of carpet texture. Such a consistent and reliable instrumental method could play an important role in product design, performance evaluation and quality control in carpet manufacture.
The Local Government Manager as a Transformational Leader
Authors: Abels Michael 
Published: March 2008

Local government managers fnd their organizations in an era of unparalleled political chaos. Accentuating this environment, an extremely angry public is the catalyst for the take over of policy making by radical minorities, and is precipitating the election of representatives who believe they must embrace a political philosophy oriented to satisfying the platform of single issue negative minorities. This vacuum of political leadership requires a new generation of managers. To counteract political negativity mangers must become transformational leaders. Transformational leadership will require that managers mobilize proactive citizen groups to perform legislative intervention with the policy making body.
Leaders, Followers, and the Visioning Process
Authors: Marcus Laurence R. , Smith Richard R. 
Published: March 2008

One of the most often cited leadership competencies is the ability to inspire an organizational vision. However, numerous authorities on the topic caution that the vision cannot be the personal construct of the leader. They contend that major stakeholders should be involved in the development of a shared vision that will inspire commitment to organizational goals. This study examines the results of an effort to use a participative model in the visioning process at a publicly supported comprehensive university.
Understanding The Charismatic Leader-Follower Relationship: Promises and Perils
Authors: Dumas Colette , Sankowsky Dan 
Published: March 2008

The authors propose a framework for analyzing the dynamics of the leader-follower relationship in a mentoring context. To illustrate their framework, they use personal disclosure and personal case analysis. This framework addresses a power imbalance that can characterize the charismatic leader-follower relatonship, affecting motivational assessment, resource allocation and evaluation processes. The authors conclude with guidelines for follower self empowerment and leader preventive maintenanace to help avoid such power imbalances in the future. Perhaps there needs to be a label announcing that "having a charismatic mentor may be hazardous to your mental health." While there is great appeal in working with someone of charisma, subtle forces at work within the relationship may undermine the follower's sense of self. In this article, we present a framework for analyzing the dynamics of the leader-follower relationship in a mentoring context. This framework addresses a power imbalance that can characterize the charismatic leader-follower relationship, and which affects motivational assessment, resource allocation, and evaluation processes. Following along a newly established path of scholarly disclosure (Neck, Godwin & Spence, 1996; Sankowsky, 1997; Gould, 1989), the authors will illustrate this framework using examples from their experiences with charismatic mentors.
Fire Resistant Cotton Blends Without Fire Retardant Finish
Authors: Reeves Wilson A. , Summers Teresa A. 
Published: March 2008

Cotton, a modacrylic (SEF), and polyester fibers were ground, blended, and made into pads weighing the equivalent of 4.8 oz. per square yard. The pads were treated with a durable press resin (DMDHEU), Sb2O3 or a combination of the two. The purpose was to develop technology for producing fire resistant durable press cotton blend textiles without the use of fire retardant chemical finishes. The pads were analyzed with and without the finishes for ease of ignition, rate of burning in the horizontal position, and Oxygen Index (01). Cotton and cotton/PE blends easily ignited, readily burned and ex hibited low Ols. The presence of SEF had a highly significant effect on all of the fire resistant test results. DMDHEU, Sb2O3 or DMDHEU plus Sb2O3 increased fire resistance of cotton and all blends. Considerable fire resistance, as measured by ignition, rate of burning, and 01 was obtained by application of the durable press resin to cotton/SEF and cotton/SEF/PE blands.
Non Woven Substrates for Coating
Authors: Upton George V. 
Published: March 2008

The market for non-woven substrates for coating has grown to be a large and complex industry. Of the various non-woven materials available for use, the largest volume is produced by needle punching. This method offers the widest range of variables for consideration by the fabric engineer and user. In the selection of fiber from which the non-woven fabric will be needled there are a range of variables to be considered. The first is the polymer to be used, with polyester and polypropylene being the two principle products for coating substrates. The staple fibers are available in deniers from 1 to 110, and lengths from 1 ½ "to 7½ ". The fibers can be of various cross sections, receive various lubricant and anti stat coatings, and be crimped in a variety of configurations to aid in anchoring into the fabric. Once all the decisions on fiber are made, the process of needling the fiber to make fabric can begin. The bales are unbundled, the fibers are carded to align and orient, crosslapped to build up the thickness, and needled under precise control with specific needle selection to pro duce the desired finished fabric. Several examples illustrate how the proper selection and control of fiber and process can provide coaters with exactly the substrate needed for specific applications. Extensive taxi and police car trials in Baltimore and Chicago proved the superiority of non-woven over knit goods, and led to the use over the past 10 years of non-wovens in General Motor cars. Styling changes demanded fabrics of entirely dif ferent character which was achieved using needle punched fabric by a dramatic change in variable selection. Many problems in the attach ment and use life of auto vinyl roofs were solved with a foam non- woven combination incorporating various inhibitors in the fabric preparation before vinyl coating. Other examples from golf bags to pond liners illustrate the benefits of non-wovens as coating substrates.
Optimisation of bronchial brachytherapy catheter placement with a modified airway stent
Authors: Kennedy M. P. , Jimenez C. A. , Chang J. , Fossella F. , Eapen G. A. , Morice R. C. 
Published: March 2008

Brachytherapy is a modality of treatment available for lung cancer with tracheal involvement. Correct positioning of the brachytherapy catheter is vital to the optimisation of treatment effect and reduction of complications. Normal airway anatomy and tumour location can make this positioning difficult.The current study presents the case of a 65-yr-old male with invasive tracheal squamous cell carcinoma of the anterior main carina involving the proximal left and right bronchus.The patient was successfully treated with brachytherapy using a novel modified airway stent with a traversing suture for positioning and stabilising the brachytherapy catheters and maximisation of the radiation effect.This simple yet innovative modification of readily available bronchoscopic equipment permits approximation and fixation of a brachytherapy catheter to any part of the proximal airway. Further analysis of this technique, including a prospective controlled trial, is planned.
Congenital anomalies and early functional impairments in a
prospective birth cohort: Risk of schizophrenia-spectrum disorder in
adulthood
Authors: Waddington John L. , Brown Alan S. , Lane Abbie , Schaefer Catherine A. , Goetz Raymond R. , Bresnahan Michaeline , Susser Ezra S. 
Published: March 2008

BackgroundAdversities operating over intrauterine life have been associated with
risk of schizophrenia, but the biology of resultant developmental
perturbation is poorly understood.AimsTo examine the relationship of congenital anomalies and related
functional impairments in infancy to risk of schizophrenia.MethodUsing the Congenital Anomalies data-set from the Prenatal Determinants of
Schizophrenia birth cohort, congenital anomalies and related functional
impairments were categorised and related to subsequent risk of
schizophrenia-spectrum disorder.ResultsThe presence of any hypothesis-based congenital anomaly or related
functional impairment was associated with a doubling of risk of
schizophrenia-spectrum disorder. In contrast, having any other congenital
anomaly or related functional impairment was not associated with risk of
schizophrenia-spectrum disorder.ConclusionsThese findings constitute evidence for early events, which may result
from both genetic predisposition and environmental insults, in the
pathogenesis of schizophrenia.
A pilot personality disorder outreach service: development, findings and lessons learnt
Authors: Lee Tennyson , McLean Duncan , Moran Paul , Jones Hugh , Kumar Anil 
Published: March 2008

Aims and MethodWe describe the development of a pilot personality disorder outreach service. A case series of 13 patients was studied. Data were collected using pro forma, semi-structured interviews and a structured assessment of personality disorder.ResultsAll personality disorder clusters were represented among the 13 patients. Treatment recommendations usually supported the existing approach – the ‘added value’ of the outreach service was that difficult interpersonal dynamics could be considered and thought through with an objective observer. Opinions differed on whether the service was more useful for the assessment and brief treatment or continuing care teams.Clinical ImplicationsPersonality disorder services need to develop expertise in all clusters. There is a need to moderate the harsh self-critical attitudes of the care coordinators. The national framework for personality disorder is useful for service development, but the services need to be tailored to the individual needs of specific teams.